Steroid Treatment for Multiple Sclerosis

It’s likely that the vast majority of us on this site have had at least one infusion of corticosteroids for our Multiple Sclerosis. Names like methylprednisone (Solu-Medrol) and dexamethasone (Decadron) are not unfamiliar to those of the compromised myelin. I promised a discussion on the topic in a posting a few weeks back, and the time has come.

Corticosteroids are synthetic replications of natural hormones produced in our adrenal glands. They seem to have an anti-inflammatory function and were some of the first drugs used to combat MS attacks, going back decades.

Corticosteroids differ from anabolic steroids in almost every way, other than they are derived from a hormone (male testosterone). When being administered corticosteroids, one need not worry about the side effects we read about when athletes use these drugs.

In layperson’s terms (not that we’re of the lay persuasion when it comes to MS), this form of drug helps to shrink the swelling around an active lesion in the central nervous system. Current evidence shows that, months out from an exacerbation (attack), a person is likely to be in the same place clinically with the disease, with or without the use of corticosteroids.

Doctors, or at least the ones I have spoken with about the topic, say they’ll continue to use these steroids during acute exacerbations because patients demand they do something.

In most cases, a 3-5 day infusion of high-dose corticosteroids (likely with a few days of oral taper) does relieve many of the symptoms of the attack. When I write “most cases,” that’s most attacks, not most patients. Some patients will respond well most of the time, and the drugs will do nothing for others. Of course, I write in clinical generalities.

For patients with active disease, it is not uncommon to be placed on monthly “pulse” doses of these drugs. The theory here seems to be, if a big dose helps when inflammation is uncontrolled, small doses will keep it in check. For people I have talked with in this category, treatment seems to have them in a better place than without.

All of this is leading up to the side effects, as you might have imagined. The National MS Society Sourcebook on the topic states the following:

“Possible side effects include stomach irritation, elevated blood sugar, water retention, restlessness, insomnia and mood swings…The side effects of long-term continuous steroid use are serious and well-documented. These include stomach ulcers, weight gain, acne, cataracts, osteoporosis (thinning of the bone), deterioration of the head of the thigh bone and chemical diabetes.”

“Mood swings”: that’s a nice way of saying ‘roid rage!

As many of you have understood from the past two weeks, I have experienced some of that “deterioration of the head of the thigh bone” called avascular necrosis and have had a 10cm rod cut, drilled and hammered into the head of my femur. Not something I had ever considered when I was going in for my six three-day infusions of Solu-Medrol in the first 18 months after diagnosis.

I’m not bitter (well, maybe a little aftertaste…) but I wanted to use this bully pulpit to open the conversation for others who dislike using these drugs, but don’t know what else to use, or worse, have a doctor who “forces” them on you.

Let’s see where this discussion takes us, shall we?

By the way, for those who were wondering: I am, today, two weeks out from surgery. I am only using a cane to get around and need very little (if any) pain medication. The surgeon is very happy with the recovery thus far. We’ll not know if this worked for a couple of months (bone could still collapse…well, it will, eventually, we’re just hoping to buy 3-5 years here). 

Asthma Treatment Effect on Bone Health

Corticosteroids are a common asthma treatment, but are they also bad for your bones? Find out what the experts think.

If you take corticosteroids as part of your asthma treatment plan, they likely play an important role in helping you manage your asthma symptoms. But some studies also link this type of drug, commonly available in the form of an asthma inhaler, to bone loss and osteoporosis.

Dozens of studies starting in the late1990s and continuing into the early 2000s have tied corticosteroid to osteoporosis. When corticosteroids are administered for a long time, and in high doses, the side effect of osteoporosis is a common problem. This has been shown both in asthma patients, in addition to patients taking corticosteroids for other reasons.

What the Experts Say About Corticosteroids and Osteoporosis

While the issue of osteoporosis may be a concern for patients with severe asthma who have to take high doses of corticosteroids, the average asthma patient who just has to use an asthma inhaler shouldn’t have to worry too much about it, says Ronald M. Ferdman, MD, an assistant professor of pediatrics at the University of Southern California.

“At typical doses, we don’t see any problems,” says Dr. Ferdman. “Of course, there are people who for reasons unknown are exquisitely sensitive to even low-dose steroids who may have some bone effect, but these instances are rare. If a patient is on high-dose inhaled steroids for a long period of time (years), it is not unreasonable to check for the development of osteoporosis, but it is not routinely done because the effect is so rare and so minimal.”

Indeed, it seems that osteoporosis is a very rare side effect of all types of inhaled steroids through an asthma inhaler, which is the most common use of these drugs as an asthma treatment. However, the side effect of osteoporosis is much more common when taking oral corticosteroids in pill form. This form of corticosteroid is seldom used for asthma, and only in severe cases.

“Oral steroids can be given as a ‘burst’ (usually around five days) to treat an asthma attack,” says Ferdman. “Very rarely, patients with the most severe asthma must take an oral steroid daily for months or years at a time to control their asthma. In these patients that must take oral steroids daily, osteoporosis is a very real risk, and they should be monitored for it and treated if needed. For patients who need short oral ‘bursts,’ we usually don’t monitor for osteoporosis unless they require very frequent and ongoing bursts,” he says.

Corticosteroids and Osteoporosis: What You Can Do About It

As mentioned above, frequent monitoring of the bones of patients on daily oral corticosteroids is critical in preventing future problems with osteoporosis. Your doctor may do this through a bone density screening. Your doctor may also want to check your testosterone level (for males) or estrogen level (for females) to make sure that you don’t have a deficiency.

If you have to take oral steroids daily, your doctor may also prescribe calcium and vitamin D supplements, which have been shown to help with some of the bone loss associated with long-term oral corticosteroid use. Hormone-replacement therapy has also been used in older women to fight off some of the effects of osteroporosis.

When it comes to the inhaled steroids used to treat asthma, however, our experts reiterate that the side effects of bone loss are rare, and the benefits of the corticosteroids far outweigh the risks. “Corticosteroids are very valuable in treating asthma. They help decrease inflammation in the lungs, so the small airways or bronchials stay open,” says Nick Peters, MD, vice president of Medical Operations for Concentra. “Now that physicians can offer this valuable medicine by an inhaler, the side effects are nearly eliminated. Short-term use of steroids has minimal side effects.” 

Arthritis Treatment With Steroids

Main target of rheumatoid arthritis treatment is to stop inflammatory process because with time inflammation becomes a permanent disturbing factor and source of pain and discomfort.

Corticosteroids (also called steroids) are second major group of drugs which are used against inflammations in people with rheumatoid arthritis/ This group of drugs prevents body from production of substances (called prostaglandins) that may cause inflammations.

Corticosteroids perform one more function in rheumatoid arthritis. There is evidence that rheumatoid arthritis is an autoimmune disease. It means that immune system mistakenly acts on healthy tissue instead of fighting bacteria and viruses.

Corticosteroids reduce autoimmune activity, thus eliminating its potential harm. Steroids make blood leukocytes work less effectively. Unfortunately it means that in the meantime in different people by different degree lowers immune system ability to resist infections.

Corticosteroids are not only drugs but also hormones that are produced from cortisone. Cortisone is produced in atrabiliary capsules and it has an effect on many vital functions in the body. Cortisone regulates fluid-and-electrolyte balance and metabolism of proteins, fats and carbohydrates.

Stress makes atrabiliary capsules produce additional amounts of cortisone which helps the body fight stress. However, you should know that corticosteroids and anabolic steroids are two different things. In arthritis treatment anabolic steroids are not used.

What Diseases Do Treat Steroids?

Steroids (corticosteroids) are synthetic drugs with properties similar to cortisol (hormone that is produced in human body). Steroids reduce inflammation and inhibit hyperactivity of immune system. Steroids are used to treat different diseases which are followed by inflammatory processes. Corticosteroids do differ from anabolic steroids which are used by athletes to build muscles. Corticosteroids include cortisol, prednisone and methylprednisolone.

How steroids are used?
Steroids may be taken by mouth (oral steroids) or may be injected (injectable steroids). Injections may be made intravenously, intramuscularly, directly in affected joint or synovial bursa (obtundent surface between particular chordas and bones), and chordas area and other limp juxta-articular tissues.

How do steroids work?
Steroids eliminate inflammatory process and reduce activity of immune system।Inflammation is a process during which leucocytes and other enzymes do activate body defense against infections and foreign substances such as viruses and bacteria However, some diseases break immune system work which leads to development of its hyperactivity. Inflammation comprises articular tissues and destroys them. Inflammation is followed by redding of affected area, turgidity and pain. Steroids reduce production of inflammatory ferments preventing from further tissue erosions. Also steroids reduce the activity of immune system by inhibiting leucocytes function.

What diseases do treat steroids?
Steroids are used to treat conditions characterized with break of body defense system work which destroys articular tissues. Steroids are used in particular conditions which are followed by inflammations, such as systemic angiitis (inflammation of blood vessels) and myositis (inflammation of muscles). Also steroids may be used to treat such inflammatory diseases as arthritis, lupus, uratosis.