Corticosteroids are a class of medications commonly prescribed to treat inflammation.
While they are often referred to as steroids, it is important to note that they are not the same as performance-enhancing drugs used in sports.
Corticosteroids tend to be used in the short-term, for fibromyalgia flares. For chronic pain and fatigue in fibromyalgia, the recurrent use of corticosteroids are not indicated.
Fibromyalgia should not be seen as a disease that needs treatment, but rather as a clinical condition that requires control. This is because, in the predisposed person, its manifestations occur throughout life, depending on a range of physical and emotional factors. In this context, manifestations must be treated considering their severity.
Anti-inflammatories, analgesics and corticosteroids generally have little or no benefit in minimizing symptoms. Antidepressants and neuroleptics are the most indicated pharmacological agents.
The treatment of pain and other symptoms of fibromyalgia usually does not improve with the use of simple analgesics or anti-inflammatory drugs, often prescribed by doctors who are not familiar with the disease.
In this article, we will explore the various types of corticosteroids, how they work, and their applications in treating a variety of medical conditions.
What are Corticosteroids?
Corticosteroids are substances used to reduce inflammation or activity of the body’s immune system. In this way, the effects of the corticoid alter the action of the hormone cortisol, influencing the functioning of skin cells, fatty tissue or bones.
The use of corticosteroids is related to health problems such as rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, irritable bowel syndrome, and even in the treatment of severe allergic or anaphylactic reactions.
It is not a commonly prescribed medication for fibromyalgia.
The Role of Corticosteroids in the Body
Corticosteroids, such as prednisone, methylprednisolone, and hydrocortisone, are synthetic medications that mimic the effects of cortisol, a naturally produced glucocorticoid hormone.
The adrenal glands, located on top of the kidneys, produce cortisol. By increasing the dose of synthetic corticosteroids, their anti-inflammatory effects can be significantly amplified compared to the natural production of cortisol.
How long do they last?
The effects of the corticoid in the body last, on average, 30 days, and this period is necessary after the last dose to be eliminated from the body.
Their benefits for acute pain in fibromyalgia can being few days after taken.
It is important to remember that, depending on the duration of drug use, dose and metabolism, the substance may take longer to be eliminated.
Dangers of corticosteroids abuse
Corticoids are synthetic hormones that, as well as having an excellent effect on the body, can be dangerous, causing various dangerous situations. This risk is even greater when its use is not accompanied by a doctor.
Corticosteroid side effects are more common in cases of prolonged use. Among them, the person may experience fatigue, increased blood sugar levels, decreased body defenses, agitation, insomnia, increased cholesterol and triglycerides, headache and glaucoma.
Risks of continuous use
Because it is a drug with a great effect, corticosteroids cause more serious problems when used continuously. In these cases, the drug is related to cellular alteration in different parts of the body.
People who suffer from incurable rheumatic diseases, such as rheumatoid arthritis, may be at risk of worsening the condition of the disease when using this medication, since they may become dependent on the corticosteroid and, when withdrawn, there is a significant worsening.
With this type of use, the person is more likely to have adverse reactions and also exacerbate existing health problems. In situations where the individual is undergoing cancer treatment, the indiscriminate use of corticosteroids to relieve pain, using doses beyond what was recommended by the doctor, can contribute to the cancer spreading to other parts of the body.
For this reason, the use of medication such as corticosteroids should only be done with medical advice, always respecting the dosage indicated by the professional as a way to avoid further problems.
Mechanism of Action
Corticosteroids work to decrease inflammation by binding to glucocorticoid-specific receptors present on nearly every cell in the body.
Once bound, the cells send signals to reduce the production of proteins and other cells that promote inflammation and activate the immune system. Additionally, corticosteroids activate and inhibit certain genes to increase the production of anti-inflammatory pathways, making them potent anti-inflammatory medications.
Forms of Administration
Corticosteroids can be administered in several ways: orally, intravenously, topically, via inhalation, or through injection. Each method has its unique applications and benefits.
- Oral steroids: Commonly prescribed as pills or tablets, these medications include prednisone, methylprednisolone, and hydrocortisone. They can be taken once or twice daily, depending on the patient’s preference and potential side effects, such as difficulty sleeping.
- Intravenous (IV) steroids: Administered by a medical professional, IV steroids are used when a patient cannot take oral medications or when high doses are required. These steroids include methylprednisolone, hydrocortisone, and dexamethasone.
- Topical steroids: Available as gels or creams, topical steroids are used to treat inflammatory skin conditions like eczema, psoriasis, and poison ivy.
- Inhaled steroids: Used to treat asthma or chronic obstructive pulmonary disease (COPD), examples of inhaled steroids include fluticasone, beclomethasone, and budesonide.
- Injectable steroids: Delivered via a needle directly to the target joint, tendon, or tissue, injectable steroids are often used to treat arthritis, osteoarthritis, or joint and tendon inflammation, such as bursitis.
Common Conditions Treated with Corticosteroids
Corticosteroids are used to treat a wide range of conditions, including lung conditions, allergic reactions, and autoimmune or rheumatologic diseases.
- Lung conditions: Asthma, one of the most common lung conditions globally, has been treated with steroids since the 1950s. Both inhaled and oral corticosteroids can help relieve acute asthma attacks and prevent recurrence.
- Allergic reactions: Corticosteroids can help stop the immune reaction that occurs during an allergic reaction. Both oral and intravenous steroids play a crucial role in treating severe allergies, which can cause life-threatening complications such as airway swelling.
- Autoimmune and rheumatologic diseases: Corticosteroids are often used as a first-line treatment for autoimmune diseases, where the immune system mistakenly attacks the body’s own tissues. Examples of autoimmune diseases include rheumatoid arthritis, vasculitis, Crohn’s disease, ulcerative colitis, and multiple sclerosis. These conditions often require long-term treatment with immunosuppressing medications to manage the overactive immune system and limit the long-term use of steroids.
Studies of corticosteroids and fibromyalgia
In 1985, a study was done to compare the effects of prednisolone (a type of corticosteroid) versus placebo in 20 patients with fibromyalgia[1]Clark S, Tindall E, Bennett R. A double crossover trial of prednisone versus placebo in the treatment of fibrositis. J Rheumatol 1985 Oct; 12(5): 980–3.
The study found no improvement while taking the prednisolone, and most measured variables showed a trend towards deterioration. This study showed that corticosteroids should not be part of the treatment for fibromyalgia. If a patient with fibromyalgia does respond positively to corticosteroids, then the diagnosis should be reconsidered.
Conclusion
Corticosteroids are a versatile and potent class of medications that play a critical role in managing inflammation and immune system-related conditions. With various forms of administration, they can be tailored to effectively treat a wide range of ailments, from lung conditions and allergic reactions to autoimmune and rheumatologic diseases.
For patients with fibromyalgia, they should be used with caution for acute pain. For chronic pain, and other symptoms, their recurrent use is not indicated. The drugs used are antidepressants, muscle relaxants and neuromodulators.
It is essential to work closely with healthcare professionals to ensure appropriate use and dosage to minimize potential side effects and maximize therapeutic benefits.
Physiatrist, M.D. Pain Center of University of São Paulo
References
| ↑1 | Clark S, Tindall E, Bennett R. A double crossover trial of prednisone versus placebo in the treatment of fibrositis. J Rheumatol 1985 Oct; 12(5): 980–3 |
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