Prednisone is a medication widely used in rheumatology for patients suffering from inflammatory arthritis. However, prolonged therapy with prednisone can lead to many unwanted side effects.
What is prednisone?
Prednisone is a corticosteroid medication. Corticosteroids are amazing anti-inflammatory medications. Edward Kendall isolated cortisone in the late 1930s, and Philip Hench was the first that use it to treat rheumatoid arthritis in 1948 at the Mayo Clinic in Rochester, Minnesota. In 1950, these doctors won the Nobel prize. Today, Corticosteroids like prednisone are used widely in many medical specialties to reduce inflammation and modulate the immune response if it is exaggerated.
In rheumatology, corticosteroids like prednisone or methylprednisolone are frequently used for rheumatoid arthritis, lupus, and gout to vasculitis. Prednisone is our best friend! We give it to patients, and patients love us, or they are forever grateful as it will reduce the pain and inflammation in a matter of days.
We use corticosteroids as pills, IV infusions, or injections.
What are the most common side effects of prednisone?
When prescribing corticosteroids to my patients, I always educate them about the benefits and risks, the role of this medication, and the length of therapy. Therefore, if prednisone is misused or for a very long time, it may cause many side effects. This article will discuss the most common side effects you should be aware of if you receive prednisone or other steroid-type therapy.
Patients on high doses of prednisone or another steroid for prolonged periods can develop insulin resistance and in time, can develop diabetes. Patients that already have diabetes and receive steroids will notice a worsening of their glucose levels, and they might need to be very careful. Sometimes, they must adjust their diabetes medication to control their glucose blood level. It is essential to avoid eating an excessive amounts of carbs (e.g. bread, pasta, sweets) while you are taking prednisone.
Cataracts and glaucoma
Cataracts and glaucoma are problems of the eye. Patients will report visual changes like decreased vision, blurry vision, and sometimes pain in the eyes. Cataracts usually occur in patients on long-term therapy with corticosteroids, even at lower doses, like 10 mg/ day.
Osteoporosis or thinning of the bones, is a real concern especially for elderly patients. Due to osteoporosis, even an “easy” fall can lead to fractures of the bones and many weeks or months of disability, chronic pain and even death. There are patients that after a fracture can develop a thrombi or clots in their legs that can go to the lung and cause a pulmonary embolism.
Osteonecrosis is different from osteoporosis. Avascular necrosis (AVN) or aseptic necrosis, is the death of bone cells due to decreased blood flow. It can lead to pain and collapse of areas of bone. Usually this happens after years of being on steroids (high or low doses of steroids).
Yes, bruising and delayed healing of the skin are also common complications of long-term therapy with prednisone. Many patients will report that with easy trauma or no obvious trauma they will see large areas of bruising on their skin. If by accident, they cut/ injured their skin, the healing process can take weeks.
Corticosteroids will make you hungrier, this is a reality. That is why I encourage all my patients that need this medication to avoid excessive use of carbs like bread, pasta and eliminate sugar from their diet. Many patients gain weight rapidly on prednisone and that becomes a real problem.
Increased risk of infection
Unfortunately, larger doses of prednisone >20 mg/ day will increase your risk of infections, especially opportunistic infections like Tuberculosis or candida but also staphylococcal infections, and virus infections (like CMV virus or herpes zoster) are more frequent in patients taking steroids.
Some patients develop shingles on large doses of steroids, as this medication will lower their immune system and the virus will become active.
Hypertension or an increase in blood pressure may happen in patients on corticosteroids as they may increase salt and water retention in the body. That will cause an increased volume in your arteries and an increase in blood pressure.
That is why I advise my patients to reduce the amount of salt they eat , while taking prednisone.
Steroids can cause agitation, anxiety, difficulties to focus, fear, insomnia, irritability, loss of interest, labile mood, pressured speech, agitation and tearfulness. Some patients can develop anxiety, palpitations, depression, mood swings and even psychosis.
Because steroids affect areas of the brain that manage the regulation of different neurotransmitters, including serotonin and dopamine — the “feel-good” hormones. So it is not uncommon to be very happy one day and very depressed on the next day.
Prednisone can also affect your sleep, it may make you agitated and unable to sleep at night time . That is why I tell my patients to try to take a bigger dose in the morning, that will mimic the natural release of steroids in our body.
Large doses of corticosteroids, especially in combination with other anti-inflammatory medications (e.g NSAIDs) can cause ulcerations in the gut and even a gastrointestinal bleed. So pay attention to your stool and if you see any dark stools or any red blood in your stool, contact your doctor immediately and discuss this side effect.
These are the most common side effects, but not all possible side effects of corticosteroids. If you need this type of medication, always discuss all the benefits and risks with your physician, that will be able to understand your situation better.
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