Systemic Corticosteroids

Abstract

Corticosteroids play an essential role in the treatment of many inflammatory autoimmune diseases and often are the first line treatment option for rapid clinical response. The significant therapeutic effects, however, are often accompanied by adverse side effects. The most common and serious complication is glucocorticoid-induced osteoporosis, remaining a potentially preventable but often poorly treated side effect. Although a rarer complication, osteonecrosis is more debilitating and occurs most commonly in patients taking higher doses of corticosteroids. Metabolic and endocrine side effects, including hyperglycemia and diabetes mellitus, are potential complications, even at low dosing. Hypothalamic-pituitary adrenal suppression with secondary adrenal insufficiency can be observed more rapidly at higher dosing or longer treatment duration, although has been observed with shorter duration and lower dosing of corticosteroids as well. Corticosteroid treatment may also induce or exacerbate psychiatric disorders such as anxiety, depression, and, less commonly, psychosis. Cardiovascular side effects may also occur with corticosteroid use including hypertension, dyslipidemia and atherosclerosis. Perhaps most notably and well-described is the increased susceptibility to infections accompanying corticosteroid use, thought to occur largely through several alterations in host defenses. Ophthalmologic side effects including cataract development and increased intraocular pressure require close monitoring in the setting of long-term glucocorticoid use. In addition, several adverse GI side effects including reflux disease, gastritis and peptic ulcers have been noted with corticosteroid use. Strategies for prevention of these adverse events remain an important component during corticosteroid management.