Corticosteroids are a medication that mimic the body’s hormone cortisol. Corticosteroids, also called glucocorticoids or steroids, have anti-inflammatory effects and may be used in certain cases as a treatment in people with ankylosing spondylitis (AS) to help reduce pain and inflammation. Corticosteroids come in different forms, including oral, injection, and infusions.1,2 Common oral forms include prednisone and methylprednisolone.
How are corticosteroids used in ankylosing spondylitis?
Corticosteroids can be effective in reducing inflammation, but they are potent medicines and typically only used for short-term situations. Guidelines from the American College of Rheumatology suggest that corticosteroids should only be used as a short-term treatment with rapid tapering in certain circumstances, such as a flare of AS in peripheral joints, flares during pregnancy, or flares that occur alongside flares of inflammatory bowel disease. The guidelines state that systemic corticosteroids are not recommended for long-term treatment in people with active AS. Corticosteroids may also be considered for people with AS who have not received relief from their symptoms with non-steroidal anti-inflammatory drugs (NSAIDs).2
How do corticosteroids work?
Corticosteroids imitate your body’s response to the hormone cortisol that is produced naturally in your adrenal glands, the glands located on top of the kidneys. Corticosteroids suppress multiple inflammatory pathways in the body, including genes that are responsible for producing cytokines, enzymes, receptors and proteins that are activated during the inflammatory process. Corticosteroids will usually begin working quickly.1
What are common side effects of corticosteroids?
Corticosteroids are strong medicines that carry a risk of complications and are generally used for as short a time as possible. Side effects from corticosteroids are more likely when these medications are used long-term-particularly with oral options. Corticosteroids injections do not produce as severe side effects as their oral counterparts. However, they can produce additional side effects not associated with corticosteroids pills.
Side effects and complications of corticosteroid injections may include death of nearby bone, joint infection, nerve damage, thinning of skin and soft tissue around the injection site, temporary flare of pain and inflammation in the joint (for up to 48 hours after injection), tendon weakening or rupture, thinning of nearby bone (osteoporosis), increased risk for ulcers, and whitening or lightening of the skin around the injection site. Repeated use of corticosteroid injections may cause deterioration of the cartilage in a joint. Physicians usually limit the number of injections, and corticosteroid injections are generally not given more frequently than every six weeks, and usually not more than three or four times a year.1,3
Common side effects experienced with oral corticosteroids are fluid retention, changes in blood sugar, high blood pressure, changes in behavioral and mood, increased or decreased appetite, weight gain, and difficulty falling asleep or staying asleep. Mood changes include irritability, or abnormally happy or excited mood.1,4 Long term use of any form of steroids can lead to osteoporosis, cataracts, diabetes, avascular necrosis (loss of blood supply to bones) and infections.
These are not all the possible side effects of corticosteroids. Patients should talk to their doctor about what to expect with treatment with corticosteroids.
Things to know about corticosteroids
If you experience side effects while taking corticosteroids, it is important that you do not stop your medication abruptly. Talk to your doctor, as you could experience unpleasant or life threatening withdrawal effects. Your doctor may advise a slow and steady reduction of medication over time.
People who take blood thinners may need to stop using their medication for several days before a corticosteroid injection to reduce their risk of bleeding or bruising. Consult with your healthcare professional before stopping any medication.3
People with diabetes may experience a temporary increase in their blood sugar levels following a corticosteroid injection.3
Following the injection, patients are advised to protect the injected area for a couple days, avoid strenuous activity, and apply ice as needed to relieve pain. Patients should watch for any signs of infection at the injection site, such as increased pain, redness or swelling that lasts more than 48 hours.3