Steroids as an Ongoing Treatment for Autoimmune Conditions
Steroid therapy for the management of various immune and inflammatory conditions is a tremendous weapon in the fight to control patients’ symptoms, especially those involving pain. These drugs can be a powerful and effective option when other efforts have failed, but they unfortunately come with significant negatives, especially with long-term use. Because of this, management of disease with steroids is often a balancing act, where doctor and patient must weigh the pros and cons of extended steroid use and decide on the best course of action. Here are a few things to consider.
Steroids are a common treatment for autoimmune conditions, especially skin conditions, but are they really safe to use on an ongoing basis for decades, even in low doses found in hydrocortisone creams?
The answer depends on which steroids, how strong they are, and in which form they are given. While no doctor is likely to prescribe constant steroid treatment for decades (even with mild creams), there are some forms of therapy that are more safe and tolerable than others. As a dermatologist friend of mine likes to say regarding hydrocortisone cream, “It’s so relatively weak that you could smear it all over your body constantly and probably feel no long-term ill effects.” But there are a range of creams and ointments out there, and especially when using prescription strength applications, there are concerns that may not apply with weaker treatments.
With anything but the weakest topical applications – such as oral or injectable preparations – there are always concerns and precautions when undergoing a course of steroid treatment. The degree to which it is safe to be on them for prolonged periods will depend on the particular drug and should be discussed with your doctor.
If I do use steroid treatments, is it safer to get a higher-level dosage (e.g., shots) that might do more good vs. lower-level dosage found in skin creams?
Therapeutic course and duration will depend on the condition(s) to be treated and the medications chosen to treat it/them. Sometimes clinicians may choose to administer doses in one form versus another because of proven efficacy in doing so. But as a general rule – for steroids and other medications – it is best to use the minimum effective dose that will still treat, or cure, the problem sufficiently.
With very limited exceptions, such as critical care, it is usually best to avoid high-dose steroid therapy whenever possible, because of the potential for adverse effects with long-term treatment. Such possible effects include infection, osteoporosis, cataracts, weight gain, mood swings, sleep disturbances, skin fragility and poor wound healing. Since these effects can sometimes become as debilitating as the diseases themselves, it is important for you and your doctor to discuss achieving an acceptable balance.
And if I get higher-levels dosages more than once/year, are there any studies about long-term side effects I should be aware of?
As mentioned above, the side effects from extended steroid use are well known and established as potential complications of treatment. One thing to keep in mind is that studies have clearly demonstrated that toxicity is highly correlated to the cumulative dose of steroids over time, which indicates the need for tapering and discontinuation of these meds whenever possible.
Because the long-term effects can be so nasty, doctors will often prescribe other immunosuppressants (such as cyclosporine or methotrexate) in conjunction with or instead of steroids, to help reduce the therapeutic burden of steroids alone. This way steroids can also be reserved for acute flares, when the patient truly needs them.
Is there anything naturally occurring that could be a replacement/alternative for steroid treatments?
There are several putative alternative therapies that may be of help in combating autoimmune disease, and these should be discussed with your doctor, who may adhere to some, all or none of them. A few of the more common approaches involve dietary changes, herbal treatments and hydrotherapy.
The problem is that the effectiveness of such therapies is usually anecdotal and without hard evidence. On the other hand, if something works for an individual without any potential for harm, there is little reason not to at least try it. As with all treatments – conventional and otherwise – there are some patients who swear by them, while others see no benefit at all. Any decisions regarding use of alternative or complementary treatments should of course always be discussed first with your doctor.
Questions for your doctor:
- Should I/we consider switching to alternate-day therapy after having been on steroids for an extended course? Will this help with side effects?
- Will you combine steroids with other immunosuppressants to treat my disease? If so, which ones, and what are the pros and cons?
- What can I do to prevent or treat infections while on steroids? Do I need any specific vaccinations?
- For disorders with skin involvement, which creams or ointments are best for my condition, and are they prescription or OTC? Is it better to use a cream or an ointment? Why?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at firstname.lastname@example.org.
This blog post was originally published by AutoimmuneMom.com, written by Dr. Rothbard, and first published on Apr 3, 2012.
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