Steroid-containing medicine – friend or foe?
Many commenters on my Facebook posts about musculoskeletal conditions describe how much steroids help ease their complaints and enthusiastically recommend various products to one another. The pushy activity of some has "disturbed" me, which is why I devote a separate article to the issue. It would be good to understand that steroids are not your true friend! Although they can quickly free you from unpleasant pain in certain conditions, with more prolonged use they insidiously turn against you and can cause more and more serious illnesses than the one you originally intended to treat. It is therefore worth regarding steroids with suspicion and doing everything possible to ensure that as little as possible enters your body and as rarely as possible. It is especially to be avoided that you take a pill or injection from a neighbor without knowing what you are doing to yourself.
What is a steroid?
Corticosteroids (commonly called steroids) are medicines that resemble the hormone cortisol, which is naturally produced by the adrenal cortex in your body. Synthetic steroids, however, are stronger and longer-acting than the hormones your body makes.
How steroids are introduced into the body
Steroids can be applied locally (cream or ointment), taken orally (tablet) or given by injection. The injection can be intravenous or intramuscular, but can also be administered directly into a joint or bursa (the fluid-filled sac between some tendons and the underlying bones) or into tendons and other soft tissues.
How steroids work
Inflammation is a natural process that is fundamentally important in protecting the body. Your white blood cells and chemicals produced by your body protect you from infection and from "invaders" such as bacteria and viruses. Inflammation is characterised by redness, heat, swelling and pain.
In certain diseases the body's defence system (the immune system) does not function properly and reacts with excessive activity to some substance. For example, it may mistakenly recognise the body's own substances and tissues and "turn against them", damaging them.
Steroids reduce inflammation and suppress the immune system, which is why they are used to treat various inflammatory diseases and conditions. Steroids also reduce immune system activity by affecting white blood cell function.
Which conditions are treated with steroids?
Steroids are used mainly for inflammatory conditions such as systemic vasculitis (inflammation of the blood vessels) and myositis (inflammation of the muscle), rheumatoid arthritis, multiple sclerosis, lupus, Sjögren's syndrome or gout.
What are the benefits of steroids?
When inflammation is so intense that it threatens particular organs, steroids help protect them and in many cases can be life-saving. For example, they can prevent worsening kidney failure in people with lupus or vasculitis. Without steroid therapy, people with these diseases might require long-term dialysis or kidney transplantation.
Steroids can be lifesaving in allergic reactions (for example, peanut or wasp-sting allergies). In such cases symptoms can escalate to life-threatening levels within minutes, which could be fatal without intravenously administered steroids.
Low-dose steroids significantly ease life for patients suffering from pain and joint stiffness (including rheumatoid arthritis). Short-term use of higher-dose steroids can also help during severe flares of arthritis.
Oral? Intravenous? Local injection?
When you take a steroid tablet orally, it passes through the digestive tract and organs responsible for breakdown and detoxification (the liver), so only the fraction of the active substance that remains after digestion reaches the sites (for example, joints) where it is most needed.
If steroid effect is required at a specific site—for example the knee joint—it is given directly into the problematic area (joint space, bursa, etc.) by injection. In this case there is no breakdown in the digestive system because the drug is delivered straight to the target site.
It is common to inject directly into the joints to treat conditions such as rheumatoid arthritis, gout or other inflammatory diseases. Injections are also frequently given near painful bone spurs, inflamed bursae or tendons. Some patients report relief after such injections.
Locally administered steroid injections are generally well tolerated and are less likely to cause serious systemic side effects. Injections can help avoid the need for higher doses of oral steroids.
It should be noted that systemic side effects are much more likely with oral or intravenous steroids than with local application.
What side effects can occur with local steroid administration?
Direct steroid injection into the affected area is one of the most effective ways to relieve pain and improve function, but it usually does not cure the disease – it is only symptomatic treatment!
Local steroid administration may cause the following side effects:
- flare-up of infection (due to suppression of the immune system)
- allergic reactions
- bleeding into the joint
- skin discoloration
- weakening and rupture of bone, ligaments and tendons (if injections are frequent and repeated in the same area)
Not everyone will experience side effects and they vary between individuals.
If steroid injections are rare (more than three to four months between injections), it is possible that none of the listed side effects will occur.
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Possible side effects of orally administered (oral) steroids
Side effects increase with higher doses and longer treatment. Side effects are much more common with oral drugs than with locally administered ones.
Some side effects are mild and almost insignificant, but many are so serious that they may pose a greater risk to the patient's life than the disease being treated.
Common side effects of oral steroids include:
- blurred vision, cataract or glaucoma
- sleep disturbances, insomnia
- nervousness, restlessness, sudden mood changes
- increased body hair
- thinning skin that bruises easily
- acne
- reduced defence against infections
- muscle weakness, muscle injury, strains, bruises
- osteoporosis
- stomach irritation and gastric bleeding
- swollen, puffy face, fluid retention, oedema
- increased appetite, weight gain
- development or worsening of high blood pressure
- worsening of diabetes
Note: The list includes only the most common side effects and not all possible side effects. If you suspect a side effect, contact your doctor.
I take steroids. Will I definitely have side effects?
No. The development of possible side effects varies from person to person. If steroid use is short (from a few days to a few weeks), it is possible that none of the listed side effects will occur. Generally they do not occur if a single steroid injection is given occasionally to treat arthritis, tendinitis or bursitis.
However, if you receive steroids for a longer period (several months or perhaps years), you can expect an increasing number of side effects to appear.
How can side effects be reduced?
To minimise steroid side effects:
- Use steroids only when absolutely necessary.
- If possible, choose local treatment instead of oral tablets or intravenous injection.
- Use the minimum dose necessary to control the disease.
- Use other non-drug physiotherapy treatments so you can minimise the steroid dose.
- Monitor the development of side effects.
- If treatment is necessary, do not stop the drug abruptly; taper the dose gradually.
- Check your blood pressure regularly.
- Check your blood sugar regularly.
- Have your bone density checked from time to time.
- If you notice a side effect, it should be treated. However, you should know that new drugs used to treat those side effects may cause further side effects…
Who should not take steroids?
Taking steroids—like any other medication—is not recommended for everyone. Steroids are generally not advised in the presence of:
- infectious disease
- diabetes
- high blood pressure or congestive heart failure
- stomach ulcer
- osteoporosis
- existing glaucoma
How is the decision for steroid treatment made?
Prescribing steroids is the responsibility of the doctor. The decision is always based on a thorough assessment of the individual situation. A conscientious and well-prepared treating physician will weigh your age, general health, the effects of any other medicines you take and will ensure you understand the potential benefits and risks of steroids before you start taking them.
Summary
Steroids are indispensable in many life-threatening situations where their use and possible side effects pose less risk than the danger to be averted.
However, there are many conditions that are not life-threatening but cause varying degrees of daily discomfort. Starting steroid therapy early can cause greater long-term harm to your health than the disease itself.
I know that when joint pain constantly torments a person, they are tempted to choose the rapid symptomatic relief offered by steroids. Over time, however, such hasty decisions can lead to irreversible consequences.
Before starting steroids, it is worth trying modern physiotherapy methods. These procedures have been used in healing for decades. Their effects develop more slowly than drugs, but they are completely free of side effects and have healing effects as well (unlike steroids, which only suppress symptoms).
Home-use devices such as TENS, microcurrent, therapeutic ultrasound, softlaser, magnetic therapy, cold and heat therapy and other devices can delay the need to start steroid treatment, or at least reduce the amount of medicine required – a huge advantage against side effects. Start steroids only if these methods do not bring improvement after a few weeks.
Consider carefully! This is about your long-term health and quality of life!
Frequently asked question
“How long does the steroid effect last?”
The duration of steroid effect depends on several factors, including the type of steroid, the method of administration, the dose and individual responses.
Corticosteroids and anabolic steroids have different mechanisms of action and application areas.
Corticosteroid
Synthetic versions of hormones produced by the adrenal cortex, primarily used for their anti-inflammatory and immunosuppressive effects in treating conditions such as asthma, allergies, autoimmune diseases and arthritis.
The duration of effect varies by preparation:
- Short-acting corticosteroids: biological half-life up to about 12 hours, e.g. hydrocortisone.
- Medium-acting corticosteroids: half-life 12–36 hours, e.g. prednisolone.
- Long-acting corticosteroids: half-life over 36 hours, e.g. dexamethasone.
The route of administration also influences the duration. Oral or intravenously administered steroids may act faster, whereas injections given into joints may have effects that last longer, even several weeks.
Anabolic steroid
Synthetic forms of testosterone used to increase muscle mass and enhance physical performance. The effect of anabolic steroids depends on the dose and duration of use.
With short-term use, effects may last a few days, while long-term use can produce effects that persist for weeks or months.
Non-medical use of anabolic steroids carries serious health risks, including liver damage, cardiovascular problems, hormonal imbalance and psychological issues.
Overall, how long a steroid effect lasts depends on many factors and varies between individuals. The most appropriate therapy for you should be determined by your treating physician to minimise potential side effects and maximise treatment effectiveness.
“How long does the effect of Diprophos injection last?”
The Diprophos injection is a corticosteroid preparation used to treat inflammatory and allergic conditions. Its active ingredient, betamethasone, is present in two forms: betamethasone sodium phosphate, which is rapidly absorbed and provides a quick effect, and betamethasone dipropionate, which is released more slowly and provides a longer-lasting effect.
After injection, betamethasone sodium phosphate reaches peak plasma concentration quickly, usually within a few hours, giving rapid symptom relief. The slow release of betamethasone dipropionate then provides a longer-term effect. Most of the drug is eliminated from the body within 2–3 weeks, but the clinical effect may differ from this.
The duration of Diprophos's effect depends on several factors, including the dose used, the site of injection, the type and severity of the treated condition and individual response. Generally, the anti-inflammatory and pain-relieving effects can last for days or even weeks. For example, in joint inflammations, the reduction in pain and swelling can persist for several weeks.
Side effects may occur with Diprophos injection, such as muscle weakness, osteoporosis, high blood pressure or increased blood sugar, and whitening of the skin at the injection site.
