Steroid medication – friend or foe?

What is a steroid?

Corticosteroids (briefly: steroids) are medicines that resemble the hormone cortisol — which your body naturally produces in the adrenal cortex. Synthetic steroids, however, have stronger and longer-lasting effects than those produced by your body.

It is important to distinguish corticosteroids from anabolic steroids. Anabolic steroids are synthetic forms of testosterone used to increase muscle mass — we will not discuss those here. The primary effects of corticosteroids are reducing inflammation and modulating the immune system.

How are steroids delivered into the body?

Steroids can be administered in several ways:

• Topically – as creams, ointments, or eye drops
• Orally – tablets, capsules
• By injection – into a vein, into a muscle, or directly into a joint or soft tissue
• By inhalation – for asthma and COPD

The route of administration greatly affects the risk of side effects. Local application (cream, eye drops, inhalation) generally causes fewer systemic side effects than oral or intravenous steroids.¹

How do steroids work?

Inflammation is a natural process that is fundamentally important for the body's defense. Your white blood cells and substances produced by your body protect you from infections and invaders. Inflammation is characterized by redness, heat, swelling and pain.

However, in certain diseases the immune system does not function properly — it reacts with excessive activity or mistakenly recognizes the body's own tissues and "turns against" them. In such cases steroids can help reduce inflammation and the immune response.

In which conditions are steroids used?

Steroids are used to treat many inflammatory and autoimmune conditions:

• Rheumatoid arthritis and other inflammatory joint diseases
• Systemic vasculitis (inflammation of blood vessels)
• Lupus and other autoimmune diseases
• Severe allergic reactions
• Acute exacerbations of asthma and COPD
• Inflammatory bowel diseases
• Skin inflammations (dermatitis, psoriasis)

When can steroids be particularly important?

There are situations where steroids can play an indispensable role. In severe allergic reactions (anaphylaxis) — for example in nut or wasp-sting allergies — symptoms can rapidly worsen. In such cases intravenous steroids can be crucial for stabilizing the condition.²

In certain autoimmune diseases where inflammation threatens vital organs (for example kidney involvement in lupus), steroids can help prevent severe organ damage.

Local steroid injections

When steroid action is needed in a specific area — for example in an inflamed joint — the drug is often injected directly there. This can be into the joint space, the bursa (fluid-filled sac), or around a tendon.

The advantage of a local injection is that the active substance is delivered immediately to the target site, a smaller amount is sufficient, and the risk of systemic side effects is lower than with oral steroids.

If you want a detailed guide on the procedure, effects and risks of steroid injections, read our detailed guide: Steroid injection (cortisol shot) – what to know.

Side effects of oral steroids

The risk of side effects increases with dose and the duration of treatment. Up to 90% of people on regular, long-term steroid therapy may experience some side effect.¹

Based on scientific research, the most common side effects are the following:

Skeletal effects

Steroids are one of the most significant risk factors for the development of osteoporosis. Long-term steroid users may experience bone loss in up to 40% of cases, which can lead to fractures.³ Bone loss can begin within the first 6–12 months of treatment.

Metabolic changes

• Increased blood sugar – development or worsening of diabetes
• Weight gain, increased appetite
• Elevated blood pressure
• Changes in fat distribution (moon face, buffalo hump)

Psychological effects

Steroids can affect mood and cognitive functions. Insomnia, restlessness, mood changes, and less commonly depression or manic symptoms may occur.⁴

Other side effects

• Increased susceptibility to infections (due to immune suppression)
• Muscle weakness
• Skin thinning, slower wound healing
• Increased risk of cataract and glaucoma
• Gastrointestinal problems

Before you start steroid treatment

For safe steroid use it is important to be aware of precautionary considerations. If any of the following conditions apply to you, discuss them with your doctor:

When should you be especially careful?

• Diabetes: Steroids raise blood sugar levels and can worsen diabetes control
• Osteoporosis: Steroids can further weaken the bones
• High blood pressure or heart disease: Steroids can increase cardiovascular risks
• Infectious disease: Active infections may be worsened or healing delayed by steroids
• Peptic ulcer disease: Steroids can exacerbate stomach problems
• Pregnancy, breastfeeding: Only after careful medical consideration
• Glaucoma: Steroids can raise intraocular pressure

How can you reduce the risk of side effects?

If you need steroid treatment, the following measures can help minimize risks:

• Use steroids only when truly necessary
• If possible, choose local application over systemic (tablet, injection)
• Use the lowest effective dose for the shortest possible time
• Never stop suddenly – gradual tapering is required
• Regularly monitor your blood pressure, blood sugar and bone density
• Ensure adequate calcium and vitamin D intake

Physiotherapy as an alternative

For many musculoskeletal problems, physiotherapeutic methods can be a real alternative to steroids — or at least reduce the amount of drug needed.

A 2020 randomized clinical trial published in the New England Journal of Medicine showed that for patients with knee osteoarthritis, physiotherapy produced better pain and function outcomes at one year than steroid injection.⁵

Another study on tennis elbow (lateral epicondylalgia) found that while steroid injections produced faster short-term improvement (under 6 weeks), the group receiving steroids had a higher rate of recurrence at one year.⁶

These results do not mean that steroids are useless — in certain situations they can be very valuable. But they show that for long-term outcomes it is worth considering physiotherapeutic methods as well.

Physiotherapy options for home

Modern physiotherapy devices make it possible to apply methods at home that were previously only available in clinics. These can help relieve your symptoms and reduce steroid requirements:

• TENS (transcutaneous electrical nerve stimulation): Can help relieve pain
• Laser therapy: Research suggests it may favorably influence inflammatory processes
• Magnetic therapy (PEMF): May support tissue regeneration
• Therapeutic ultrasound: Can help treat deeper tissues

Summary – Quick overview

What is this article? A comprehensive guide to corticosteroids: what they are, how they work, their benefits and risks, and what alternatives exist.

Who is it for? For anyone receiving or considering steroid treatment, living with a chronic inflammatory disease, or interested in physiotherapy alternatives.

Main message: Steroids are effective medicines that can be indispensable in certain situations. However, long-term use carries significant side effects. Physiotherapeutic methods often offer real alternatives or supplements, helping to reduce steroid needs.

Frequently asked questions

How long does a steroid last?
The duration of effect depends on the preparation and the route of administration. Short-acting preparations (e.g. hydrocortisone) may wear off within 12 hours, while long-acting ones (e.g. dexamethasone) can act beyond 36 hours. With local injections, effects can last for weeks.

Will I definitely have side effects?
Not necessarily. With short-term, low-dose use side effects are less common. The risk increases with dose and duration of treatment.

Can physiotherapy replace steroids?
In some cases yes, in others the best solution may be a combination of both. This always requires individual assessment. Discuss options with your doctor.

How long does a Diprophos injection last?
Diprophos (betamethasone) contains two components: a fast-acting and a slow-release part. The fast component works within hours, while the depot effect can last for weeks. Most of the drug is eliminated from the body within 2–3 weeks.

Sources

1. Liu D, et al. (2013). A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. PMC3765115
2. Yasir M, et al. (2023). Corticosteroids. StatPearls. NBK554612
3. van Staa TP, et al. (2002). The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. PubMed: 12378366
4. Brown ES, et al. (2004). Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion J Clin Psychiatry. PubMed: 15014624
5. Deyle GD, et al. (2020). Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. PubMed: 32268027
6. Coombes BK, et al. (2013). Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia. JAMA. PubMed: 23385272

The information in this article is for guidance only. Starting or changing steroid treatment always requires a medical decision. Home physiotherapy devices are intended to supplement medical treatment, not replace it. Consult your treating physician if you have symptoms.