Corticosteroids (Steroids) - What You Should Know

Potent Drugs Tame Inflammation Quickly

Tom Grill/The Image Bank/Getty Images

Corticosteroids or glucocorticoids, often just called "steroids", were once thought to be miraculous. In 1948, at the Mayo Clinic in Rochester, Minnesota, a group of arthritis patients was given daily injections of a corticosteroid. The results were so striking and the improvement so dramatic, doctors thought that the "cure" for arthritis had been discovered. However, as the use of corticosteroids expanded over the years, side effects emerged.

High doses given over prolonged periods of time turned steroids into "scare-oids". Patients were warned of the potential problems, the use of corticosteroids became more conservative, and some patients even declined treatment because they were fearful.

In fact, corticosteroids are powerful drugs that can be valuable if they are administered within proper guidelines. Understanding how they work and how they can be used safely is essential.

What Exactly Are Corticosteroids?

Corticosteroids are drugs closely related to cortisol, a hormone which is naturally produced in the adrenal cortex (the outer layer of the adrenal gland).

Corticosteroids include:

The Role of Cortisol

Cortisol plays an important part in controlling salt and water balance in the body, as well as regulating carbohydrate, fat, and protein metabolism.

When the body becomes stressed, the pituitary gland at the base of the brain releases ACTH (adrenocorticotropic hormone) which stimulates the adrenal glands to produce cortisol. The extra cortisol allows the body to cope with stressful situations, such as infection, trauma, surgery, or emotional problems.

When the stressful situation ends, adrenal hormone production returns to normal. The adrenal glands usually produce about 20 milligrams of cortisol per day, mostly in the morning, but they can produce 5 times that much when needed.

How Corticosteroids Work

Corticosteroids act on the immune system by blocking the production of substances that trigger allergic and inflammatory actions, such as prostaglandins. However, they also impede the function of white blood cells which destroy foreign bodies and help keep the immune system functioning properly. The interference with white blood cell function yields a side effect of increased susceptibility to infection.

Indications for Corticosteroids

Corticosteroids are widely used for many conditions. They are used to control inflammation of the joints and organs in diseases such as:

Corticosteroids are not used systemically for osteoarthritis, though they are sometimes used as a local injection into an affected joint.

How Corticosteroids Are Administered

Corticosteroids are versatile in their mode of application. They can be given:

  • orally
  • injected into the vein or muscle
  • applied locally to the skin
  • injected directly into inflamed joints

Corticosteroid drugs can also be used as ingredients contained in:

  • eye products (to treat various eye conditions)
  • inhalers (to treat asthma or bronchial disease)
  • nasal drops and sprays (to treat various nasal problems)
  • topical creams, ointments, etc. (to treat various skin problems)

Corticosteroids can be used in conjunction with other drugs, and are prescribed for short-term and long-term use. Prednisone (brand names Cortan, Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M and Sterapred) is the most commonly prescribed synthetic corticosteroid for arthritis. Prednisone is 4 to 5 times as potent as cortisol. Therefore, 5 milligrams of prednisone is equivalent to the body's daily output of cortisol. There are other synthetic corticosteroids available which differ in potency and half-life.

The List of Side Effects Is Extensive

The potent effect of corticosteroids can result in serious side effects which mimic Cushing's disease, a malfunction of the adrenal glands resulting in an overproduction of cortisol. The list of potential side effects is long and includes:

  • increased appetite and weight gain
  • deposits of fat in chest, face, upper back, and stomach
  • water and salt retention leading to swelling and edema
  • high blood pressure
  • diabetes
  • black and blue marks
  • slowed healing of wounds
  • osteoporosis
  • cataracts
  • acne
  • muscle weakness
  • thinning of the skin
  • increased susceptibility to infection
  • stomach ulcers
  • increased sweating
  • mood swings
  • psychological problems such as depression
  • adrenal suppression and crisis

Side effects can be minimized by following doctor's orders and taking the lowest effective dose possible. It is also important to avoid self-regulation of the dose, either by adding more or stopping the medication without a schedule.

Short-Term Versus Long-Term Therapy

When used as a short-term treatment, prednisone is usually prescribed at a moderate dose and reduced or "tapered" over a one or two-week period. The purpose is to achieve a sudden improvement in symptoms, but not prolong the duration of corticosteroid use.

Long-term therapy is usually reserved for severe cases of rheumatoid arthritis or related diseases. The dose is usually 5-7.5 milligrams of prednisone a day continued over the course of months or years.

High-dose steroids are given occasionally for the most rare, most severe cases of inflammatory disease. A high dose is considered daily doses of prednisone at 1 milligram per kilogram of body weight, or approximately 60 milligrams a day, given in divided doses. In such cases, the steroids are "tapered" as soon as possible.

To reduce potential side effects, the lowest effective dose of corticosteroid should be given. That's the optimal dose.

How Corticosteroids Should Be Discontinued

The dose of corticosteroids must be gradually reduced in order for the adrenal glands to resume natural cortisol production. Eliminating doses too quickly can result in adrenal crisis (a life-threatening state caused by insufficient levels of cortisol) although this is rare.

In cases where corticosteroids were taken in low doses for long periods of time, tapering can continue for months or years. Sometimes, doses are lowered by just one milligram per periodic interval to prevent flare-ups. When steroids are taken for shorter periods of time, tapering is more rapid and decreases in dosage can be larger.

Another possible complication associated with discontinuation of steroids is steroid withdrawal syndrome, or rebound effect, which is the body's exaggerated response to removal of the drug. Rebound effect can result in fever, muscle pain, and joint pain making it hard for the physician to differentiate between withdrawal symptoms and a flare of the disease itself.

Equivalent Doses of Various Corticosteroids

According to The Pill Book (Bantam Books), using 5 milligrams of prednisone as the basis for comparison, equivalent doses of the other corticosteroids are:

  • 0.6 mg-0.75 mg of Betamethasone
  • 25 mg of Cortisone
  • 0.75 mg of Dexamethasone
  • 20 mg of Hydrocortisone
  • 4 mg of Methylprednisolone
  • 5 mg of Prednisolone
  • 4 mg of Triamcinolone

The Corticosteroid Converter calculates equivalent dosages of various corticosteroids. It's an easy-to-use conversion tool, from

Injection Versus Oral Corticosteroids

A steroid shot, also referred to as a cortisone shot, corticosteroid injection, or intra-articular therapy is an injection of a steroid directly into the affected joint. This method allows doctors to use high doses of corticosteroid directly at the site of inflammation. Since it is localized, the rest of the body is spared the high concentration of the drug.

Infection at the site of injection is a possible side effect. Frequent injections into the same joint may also cause cartilage damage. Doctors use this treatment sparingly, after other options have failed, and attempt to limit the number of injections to once every few months and few in total for a particular joint.

The Bottom Line

Corticosteroids are powerful drugs which can improve symptoms and provoke incredible results. There are potential consequences associated with their use that should not be ignored. The power of corticosteroids should not be feared, but must be respected.


Kelley's Textbook of Rheumatology. Ninth edition. Elsevier. Glucocorticoid Therapy Chapter 60. Jacobs and Bijlsma.

The Duke University Medical Center Book of Arthritis, David S. Pisetsky M.D.

Arthritis: What Works, Sobel & Klein

Continue Reading