Corticosteroids are a group of powerful drugs for the treatment of joints and spine. Medicines based on steroid hormones show high efficiency in the complex therapy of arthritis, arthrosis, osteochondrosis, bursitis, humeroscapular periarthritis, and other pathologies of the musculoskeletal system.

Corticosteroids are often prescribed for severe pain when NSAIDs are ineffective. More than half of the population suffers from negative manifestations of articular pathologies and diseases of the spine, especially after 50–60 years. The benefits and harms of glucocorticosteroids, indications for use, review effective means- information that will be useful to many.

general characteristics

What are corticosteroids? These are highly active substances belonging to a subclass of steroid hormones. A characteristic feature is that the production is carried out only by the adrenal cortex. For this reason, corticosteroids do not exhibit androgenic, estrogenic, or progestogenic effects. The main types of steroid hormones that the body produces in the adrenal cortex are hydrocortisone and cortisone.

According to the European classification, the following groups of corticosteroids are represented on the pharmaceutical market:

• weak (hydrocortisone, prednisolone);
• moderate action (Lorinden, Fluorocort);
• strong (Triderm, Advantan, Elokom, Celestoderm);
• very strong (Clovate).

Functions:

• regulate protein, water-salt metabolism;
• support the correct course of various processes in the body;
• participate in important biochemical reactions;
• positively affect the state of the immune system;
• prevent and stop inflammatory processes;
• accelerate regeneration connective tissue.

When used correctly, synthetic steroid hormones act on the body in the same way as natural ones. In diseases of the spine, articular pathologies, the selection of drugs, the duration of treatment is determined by an orthopedist-traumatologist or rheumatologist. Violation of the terms of treatment, exceeding the dosage threatens with serious disorders for the activity of organs and systems, often provokes irreversible processes in the body.

It is important to remember the side effects that develop with prolonged use of potent drugs. The doctor never prescribes glucocorticosteroids for mild and moderate stages, if weaker drugs show a positive effect.

Steroid hormones are effective in treating the following conditions:

• spicy .

Important! Corticosteroids are indispensable in the treatment of severe systemic pathologies. Various forms of drugs are used for acute rheumatic fever, systemic vasculitis and lupus erythematosus, systemic scleroderma.

Contraindications

Powerful drugs have limitations. Do not use corticosteroids without a doctor's prescription.

With caution, external, intraarticular and oral use is carried out in the following cases:

• epilepsy;
• arterial hypertension;
• mental disorders;
• stomach ulcer and 12 duodenal ulcer;
• diabetes.

Strong formulations are contraindicated in the following diseases:

• problems with blood clotting;
• infectious problems in the joints or other parts of the body;
• destructive processes in the bone, incurable deformation of the joints;
• transarticular fracture;
• severe osteoporosis.

Benefit and harm

Corticosteroids are effective for the treatment of various pathologies of the joints and spine. Preparations are quite safe with strict observance of the rules of use. Patients should remember: potent compounds have both positive and negative effects on the body.

Beneficial features:

• act quickly;
• show a powerful anti-inflammatory effect;
• reduce pain in the affected joint or spine.

Side effects:

• acne, thinning of the epidermis;
• damage to muscle tissue;
• discomfort in the stomach and intestines;
• sudden mood swings, irritability;
• sleep problems;
• headache;
• increased levels of lipids and glucose in the blood;
• growth retardation in childhood, problems with puberty;
• osteoporosis, compression fractures of the spine against the background of calcium leaching;
• cataract, glaucoma;
• ulcerative lesions in the intestines and stomach;
• increase in body weight.

Important! Many patients after the first two or three procedures notice an increase in pain in the affected area, but later the discomfort disappears, the pain quickly decreases. Doctors consider such manifestations acceptable in a short period.

General terms of use

Side effects will be minimal, and the beneficial effect will be maximum with a balanced approach to prescribing, taking corticosteroids. For statutory pathologies, diseases of the spine, drugs are often prescribed in the form of intra-articular injections, injections into soft tissues near the pinched nerve root.

Strong drugs will be safe enough if the following rules are observed:

• short course of treatment. The task of corticosteroids is to break the chain of the inflammatory process. The optimal period of application is from one to five days, the maximum period is 3 months. With a longer duration of the course, irreversible changes often develop in various body systems;
• strict adherence to the doctor's recommendations, a ban on additional injections, taking pills at the initiative of the patient. Exceeding the dosage, frequency of use of potent hormonal agents negatively affects various parts of the body;
• consideration of contraindications. The introduction of hormonal compounds with absolute and relative restrictions provokes problems with weakened organs and systems, increases the risk of side effects;
• selection of corticosteroids- the task of an experienced doctor. You can not give injections, apply ointments or take pills that have shown high efficiency in the treatment of diseases of the spine, articular pathologies in relatives (neighbors, colleagues, friends). Potent agents are selected only individually: unprofessionalism is costly for health.

Overview of effective drugs

With an active inflammatory process, severe pain in the joints and spine, doctors prescribe hormonal drugs. It is important not only the effectiveness of the drug, but also the consideration of contraindications for each patient.

How to take vodka tincture for the treatment of joint diseases? We have an answer!

The rules for the rehabilitation and treatment of a fracture of the medial malleolus without displacement are described on the page.

Celeston

Characteristic:

• a highly effective hormonal agent with an active anti-inflammatory, antirheumatic, analgesic effect;
• active ingredient - betamethasone;
• noticeable glucocorticosteroid activity, elimination of negative symptoms in various forms of diseases of the musculoskeletal system;
• release form: solution and suspension for injection, tablets;
• Celeston injections are carried out in muscles, soft tissues, in the joint cavity, intravenously;
• with systemic osteoporosis, ankylosis, "dry joint", poliomyelitis, acute viral, bacterial infections, the doctor will select a different type of anti-inflammatory drug;
• against the background of active action, side effects appear in various organs and systems. To reduce the risk of negative manifestations, a short duration of the course, compliance with the dosage helps;
• at acute pain it is allowed to mix Celeston with local analgesics;
• in a pharmacy it is not always possible to find the drug Celeston. In the absence of analogues are recommended: Diprospan, Beloderm, Akriderm.

Hydrocortisone

Characteristic:

• drug for injections with active anti-allergic, anti-inflammatory action. The drug also produces an anti-shock, immunosuppressive, antipruritic, anti-exudative effect;
• active ingredient - hydrocortisone acetate (1 ml contains 0.025 g of the active ingredient);
• release form - suspension for injection, color - white with a yellowish tinge or white;
• hydrocortisone acetate - a group of naturally occurring glucocorticosteroids;
• the drug is recommended for synovitis, non-infectious arthritis, rheumatic osteoarthritis, osteoarthritis, and other pathologies of non-infectious etiology;
• the drug is injected into the gluteal muscle or intraarticular cavity;
• Hydrocortisone suspension has side effects: it is important to consider contraindications before starting the course. In particular, injections of a hormonal agent are prohibited during pregnancy, during breastfeeding, and in diabetes mellitus;
• in case of an overdose, gastric bleeding, a violation of the synthesis of one's own hormones, the development of Itsenko-Cushing's syndrome are possible;
• the average price is 150 rubles.

Diprospan

Characteristic:

• a group of hormonal steroid drugs with a wide spectrum of action;
• the composition is effective in the treatment of inflammatory and degenerative-dystrophic processes in the departments of the musculoskeletal system;
• suspension for injection. Active ingredients: betamethasone dipropionate and betamethasone sodium phosphate;
• the combination of active substances enhances the therapeutic effect of the administration of the drug, provides a prolonged action;

At acute form articular pathologies, degenerative-dystrophic changes, lesions of various parts of the spine, it is important to break the chain of the inflammatory process. Eliminating the cause of discomfort will reduce the degree of negative manifestations, reduce pain. Corticosteroids have been developed to respond quickly to acute symptoms. The list of drugs for the joints and spine will be provided by the attending physician.

Video - a tip on how to protect yourself from side effects while taking corticosteroids:

A little glucocorticoid like a glass of wine

can be useful to many (patients),

a lot of glucocorticoids, like a bottle of wine, are harmful to everyone.

T. Pinkus.

Glucocorticosteroids are compared to a double-edged sword. On the one hand, they are drugs with powerful therapeutic activity, which allow you to quickly achieve positive dynamics in the patient's condition, for example, reduce pain in severe articular syndrome in RA, and on the other hand, numerous side reactions are the reason for turning to HA when exhausted. the possibility of therapy with other drugs. Side effects of GC are usually divided into manifestations caused by hypercortisolism (Itsenko-Cushing's drug syndrome) and associated with suppression of the activity of one's own endogenous hypothalamic-pituitary-adrenal system (Table 5). The most typical side effect is weight gain with upper body obesity. Obesity is a consequence of the anabolic effect of HA on fat metabolism - an increase in the synthesis of triglycerides, fatty acids and cholesterol with a redistribution of fat.

It is assumed that in many cases the development of impotence and violation menstrual cycle may be associated not only with the intake of GCs, but also with the underlying disease.

Table 5

Side effects of glucocorticosteroids

It is not uncommon for hyperglycemia to occur, especially early in treatment. It can be compensated by an increase in insulin synthesis, but in some cases leads to diabetes mellitus.

Retention of sodium (water) and loss of potassium occurs due to the mineralocorticoid properties of some drugs (frequency 1-10%).

Long-term treatment with HA can induce atherosclerotic vascular damage, which is associated with the ability of HA to cause lipid metabolism disorders.

The mechanism of ischemic bone necrosis is not clear. It is assumed that hypertrophy of fat cells in the bone marrow leads to intraosseous hypertension and impaired blood flow within the bone tissue.

Myopathy is due to the catabolic effect of GC and occurs in 1-10% of patients. Steroid myopathies are manifested by weakness and atrophy of skeletal muscles. Most often this complication is caused by triamcinolone.

HAs are able to cause stomach ulcers by increasing the secretion of hydrochloric acid and reducing the production of mucus and bicarbonates and inhibiting the regeneration of the epithelium. Steroid ulcers are often asymptomatic or asymptomatic, manifesting by bleeding and perforation (frequency less than 1%). This complication is most often caused by prednisone.

Long-term treatment with GC may be accompanied by an increase in blood pressure and dystrophic changes in the myocardium. Arterial hypertension is caused by increased sensitivity of the vascular wall to catecholamines, sodium and water retention (frequency 1-10%).

Prolonged use of HA can lead to various skin lesions. The most characteristic are: slight traumatization of the skin, deterioration in the healing of the wound surface, the appearance of steroid acne on the face, striae. The development of skin manifestations is associated with the ability of HA to suppress collagen synthesis by skin fibroblasts. The slowdown in tissue regeneration is associated with the antianabolic and catabolic effect of HA on protein metabolism - a decrease in the synthesis of proteins from amino acids, an increase in protein breakdown.

The defeat of the vascular wall with the development of "steroid vasculitis" is more often caused by fluorinated GCs (dexamethasone and triamcinolone). It is characterized by increased vascular permeability. Manifested by hemorrhages in the skin of the forearms, the mucous membranes of the oral cavity, the conjunctiva of the eyes, the epithelium of the gastrointestinal tract. Increased blood clotting can lead to the formation of blood clots in deep veins and thromboembolism.

Treatment with high doses of HA can lead to posterior subcapsular cataracts and glaucoma.

Many patients, even on low doses of GCs, may develop irritability and insomnia. A very serious complication is steroid psychosis, which develops when prescribing high doses of prednisolone - more than 30 mg / day.

The immunosuppressive effect of HA leads to an increase in and aggravation of infections, an exacerbation of chronic infectious and inflammatory processes, the addition of a secondary infection, tuberculosis, and generalization of a local infection (frequency 10%). As a rule, infectious complications are asymptomatic due to the ability of HA to eliminate the clinical manifestations of inflammation.

The most unfavorable consequence of long-term GC therapy is osteoporosis. Thus, for example, the risk of osteoporotic fractures in RA patients treated with relatively low doses of GCs (average 8.6 mg/day) reaches 33% within 5 years. The development of osteoporosis is explained by a slowdown in the absorption of Ca in the gastrointestinal tract, an increase in the synthesis of parathyroid hormone and an increase in bone resorption, as well as a direct inhibitory effect of HA on osteoblasts.

The risk of side effects, as a rule, increases with an increase in the dose and duration of GC use (Table 6).

In addition, there is such a peculiar side effect GC as a withdrawal syndrome, the mechanism of which is not clear. Withdrawal syndrome may occur following rapid withdrawal of the drug. Anorexia, nausea, lethargy, generalized pain in the bones and muscles, general weakness develops. These symptoms are not associated with hypocorticism, resemble withdrawal symptoms in drug addicts, and are eliminated by the resumption of GC use. Suppression of the hypothalamic-pituitary-adrenal axis has been noted in patients taking even small doses of GCs for several days.

Table 6

Time and conditions for the occurrence of adverse reactions when using glucocorticosteroids

To the greatest extent, inhibition of the hypothalamic-pituitary-adrenal system is observed when taking fluorinated GCs - triamcinolone, dexamethasone, betamethasone, which have the longest action. It is believed that it takes about 12 months to restore normal synthesis of ACTH and endogenous corticosteroids after stopping treatment. During this period, in stressful situations, signs of adrenal insufficiency may develop. In this case, you should assign the GC again for a while.

Corticosteroids are steroid hormones that are produced by the adrenal cortex. All of them can be divided into two groups - glucocorticoids and mineralocorticoids. Glucocorticoid hormones (cortisol, cortisone, hydrocortisone, corticosterone) have a significant effect on protein, carbohydrate and fat metabolism.

Mineralocorticoid hormones (aldosterone, deoxycorticosterone) affect the water-salt metabolism. At the same time, glucocorticoids to some extent also affect mineral metabolism.

Currently, corticosteroid hormones and their synthetic analogues are widely used in clinical practice. And when people talk about corticosteroid drugs, they usually mean glucocorticoids.

Glucocorticoids and their effect on the human body

Glucocorticoids (glucocorticosteroids - GCS) cause many effects, as they affect all types of cellular metabolism. They contribute to the increased destruction of proteins and the formation of glucose from them and their metabolic products. The accumulation of large amounts of glucose in the blood stimulates the production of insulin, which helps tissues absorb glucose. Under the influence of GCS, the amount of subcutaneous fat and cholesterol in the blood increases.

GCS have powerful anti-inflammatory, analgesic, antipruritic, anti-allergic, anti-shock, anti-toxic and immune-suppressing effects. Therefore, they are used both for replacement therapy with a decrease in the function of the adrenal cortex, and for the treatment of many other diseases.

Of the natural glucocorticoids, hydrocortisone is currently used. In addition, today a number of synthetic corticosteroids are produced, among which are non-fluorinated (prednisone, prednisolone, methylprednisolone) and fluorinated (dexamethasone, betamethasone, triamcinolone, flumethasone and others) corticosteroids. These drugs are more effective than natural glucocorticoids, act at lower doses, and have a different ratio of glucocorticoid and mineralocorticoid activity. All this allows you to select drugs for the appointment of individual treatment of patients.

GCS are used in the treatment of patients suffering from cancer, severe infectious-allergic diseases of the joints and spine, systemic connective tissue diseases, severe allergic diseases, and so on.

Side effects of glucocorticoids

But in addition to the positive therapeutic effects of GCS, they also have a number of very dangerous side effects. With their long-term use in the blood plasma, there is a deficiency of proteins, which can lead to impaired growth and sexual development of children and adolescents. Under the influence of corticosteroids, the amount of glucose in the blood increases, which can cause the development of steroid diabetes. It enhances the breakdown and at the same time the formation of fats that are deposited in the tissues, creating excess weight and misconfiguration. Sodium and water are retained in the body - this causes the appearance of edema, but at the same time, the potassium necessary for the body is excreted.

On the part of the endocrine system, the function of the hypothalamic-pituitary-adrenal system is suppressed. This leads to dysfunction of the adrenal glands and the formation of Itsenko-Cushing's syndrome, as well as to the suppression of the secretion of gonadotropic pituitary hormones, menstrual disorders and infertility in women and sexual dysfunction in men.

The loss of potassium by the body adversely affects the condition of the heart muscle (myocardium). This leads to a decrease in myocardial contractility, cardiac arrhythmias, and the development of heart failure. Retention of sodium and water contributes to an increase in circulating blood volume (CBV) and further increases the workload on the heart. GCS also cause spasm of blood vessels, increased blood pressure and a tendency to increased thrombosis (increased risk of myocardial infarction and stroke).

Patients may be disturbed by headache, dizziness, increased intracranial pressure, agitation, insomnia, depression, impaired consciousness, psychosis, seizures. It is also possible the development of cataracts, increased intraocular pressure, damage to the optic nerve, metabolic disorders in the cornea, infection. A severe side effect of corticosteroids is the development of steroid ulcers of the stomach and duodenum and internal bleeding.

Corticosteroids, what are these drugs? Many, having seen the list, are afraid to drink the prescribed medications, hearing the word "hormonal". Because there are violations associated with it. hormonal background and metabolism. But, this is just a delusion. Of course, you should not take glucocorticosteroids without a doctor's prescription. But you can't refuse to use them. To dispel doubts about these agents, we will highlight in our article the main areas of application, indications and contraindications. Be sure to provide a list of drugs for convenience, in the table.

As a small digression (and also, for a better understanding of the information), it is worth talking about "native" steroid hormones.

Steroid drugs are a fairly broad group of drugs related to hormones. They can be independently produced in our body by the adrenal glands, being regulators of many processes.

The adrenal glands produce several types of natural corticosteroids:

• Adrenaline - is produced in the medulla and is the main activator of the body in case of an impending threat (it is also called the "fight or flight" reaction). It is responsible for the mass of processes - it expands the vessels of the brain, narrows the peripheral vessels, increases the heart rate, increases the level of glucose in the blood, etc.
• Norepinephrine is the precursor to adrenaline. It is called the wakefulness hormone. And the action is less impressive - it increases heart contractions and increases blood pressure.
• Corticosteroids are divided into 2 classes:

1. mineralcorticoids (responsible for the functioning of the kidneys);
2. glucocorticosteroids (they are used in synthetic form in medicine).

Steroid hormones affect almost every cell in the body, participating in multiple processes. They are able to change metabolism, have anti-inflammatory, anti-allergic effects, regulate blood sugar levels. Steroids can even suppress the immune system and help with shock or intoxication.

It is precisely such extensive properties that could not go unnoticed by scientists. In 1948, cortisone was first administered to a patient with rheumatism. Due to unbearable joint pains, he did not get out of bed for 6 years. However, after the course of treatment, he was able to stand up on his own.

With this discovery, a new round of medicine began, with the introduction of steroid drugs into practice.

Corticosteroids, what are these drugs: classification

In the treatment, only synthetic analogues of 2 hormones are used - cortisone (hydrocortisone), and deoxycorticosterone acetate (DOXA). This is the main division of this class of substances.

The group is also divided according to the form of release:

• For internal use.
• Solutions for inhalation.
• Injectable.
• For external use - lotions, ointments, creams.
• In the form of sprays.

In the international classification, there is a gradation of drugs for external use according to activity. There are 4 classes, where the first includes the weakest ointments, and the fourth - the most active drugs.

Often, external agents are combined with "amplifiers", so adding urea to the ointment with corticosteroids increases the permeability of the hormone, which allows the use of lower concentrations.

The addition of individual groups (acetate, phosphate, succinate) to hormones affects their absorption. So phosphates are highly soluble in water and are used for intravenous administration, providing a quick, but short-term effect. Acetates are no longer able to dissolve in the aquatic environment. Therefore, they are used as a suspension, this form will achieve a longer effect.

The addition of a fluorine group to GCS activates the anti-inflammatory effect.

Another classification divides substances according to the duration of activity:

1. Short-acting drugs - the half-life is from 8 to 12 hours. These include natural corticosteroids (hydrocortisone, cortisone)
2. Medium - in the body they linger for a longer time (from 18 to 36 hours). This group includes prednisolone, methylprednisolone.
3. Long - act from 36 to 54 hours, usually this includes hormones with a phosphate group - dexamethasone, betamethasone.

Mechanism of action of corticosteroids

Two groups of hormones are used as drugs - glucocorticosteroids (GCS) and mineralcorticoids.

GCS is prescribed for:

• replacement therapy for insufficient production of own hormones;
• suppression of synthesis;
• as a pathogenetic treatment using the features of the action of steroids.

The last point is most often used in medical practice. Active substances are able to suppress inflammation and allergic reactions, as an anti-shock agent, and they are also used for immunosuppression.

Glucocorticosteroids have several directions for suppressing the reaction. The first is to activate the synthesis of lipocortin, a special protein that cells produce in response to corticosteroids. This protein inhibits the action of phospholipase (it is produced by the cell membrane in response to damage). Braking this chain helps to remove external signs inflammation - swelling, redness, pain, fever.

Lipokortin is generally quite versatile. It limits the reproduction of proteins, antibodies, providing an anti-allergic and immunosuppressive effect.

Also, steroid hormones interrupt the production of pro-inflammatory cytokines - messenger molecules that activate the response to inflammation in the cell. And also negatively affect the genes of enzymes responsible for increasing the permeability of the vascular wall and the destruction of cartilage tissue. By the way, the inhibition of proteinase production by corticosteroids makes them especially effective in combating joint diseases.

For anti-shock action, drugs with GCS are also used. They help stop the synthesis of shock mediators, increase the “excitatory” effect of adrenaline on nerve endings (this provokes vasoconstriction, increased blood pressure, dilation of cerebral vessels).

Indications for use

Why are corticosteroids valuable? I will answer for having a wide list of appointments. However, despite their high medical significance, they should be used with caution. Doctors prefer to start treatment without hormonal therapy, adding GCS to the course only if the basic process is ineffective.

Of course, some diseases require the mandatory administration of steroid drugs, but they are all used according to special schemes.

When are glucocorticosteroids used?

1. Inflammatory diseases - rheumatoid arthritis, vasculitis, chronic hepatitis.
2. Respiratory system ailments - bronchial asthma, obstructive disease, respiratory distress syndrome (a critical condition in which pulmonary edema, acute hypoxia and respiratory failure are observed).
3. Autoimmune diseases - glomerulonephritis, rheumatism, lupus, Crohn's disease.
4. Diseases nervous system- early administration in back injuries helps to reduce the risk of complications. Also, drugs are used for osteochondrosis (when radicular syndrome occurs), neuritis, multiple sclerosis.
5. Infectious diseases - steroid drugs and reduce the body's immune response, in some cases they are prescribed to reduce the complications of ailments. So, corticosteroids are used for severe pneumonia in AIDS patients to reduce the risk of developing respiratory failure. With meningitis in children, taking it reduces neurological complications.
6. Diseases of the eye h- iritis, iridocyclitis, uveitis, scleritis (in the absence of infectious activity). The introduction of GCS requires special care, with an active bacterial or viral process, these drugs can mask the spread of infection, which leads to loss of vision. Usually eye drops, ointments are used.
7. Malignant blood diseases - leukemia, lymphoma.
8. In acute shock conditions - moreover, a high dose of the hormone is used once at once (1 gram per injection).
9. For the treatment of skin diseases - dermatoses, eczema, psoriasis, red lichen, atopic dermatitis.
10. In organ transplantation.

Dosages are selected strictly individually. to calculate the minimum - effective. This approach reduces the development of side effects. The introduction of a single dose, even the maximum, cannot cause complications, as well as a short course (a week). Mini - therapy is used for non-life-threatening diseases, while severe systemic ailments require long-term administration of corticosteroids.

To minimize side effects, there are various ways to calculate the treatment regimen - pulse therapy (administration of a large dose for 3 days), taking short-acting drugs once every 2 days.

Contraindications

Glucocorticoids, despite the wide range of applications, have a number of diseases in which their use is strictly contraindicated.

1. Pregnancy - can provoke adrenal insufficiency in the baby.
2. Severe forms of hypertension.
3. - provoke an even greater decrease in calcium in the body.
4. Diabetes.
5. mental illness, epilepsy
6. Ulcers of the gastrointestinal tract.
7. Active form of tuberculosis and syphilis (if there is no special therapy).
8. The presence of an infectious process.
9. Itsenko-Cushing's disease is an excessive production of adrenal hormones by the body.

With a course of glucocorticoids for more than 2 weeks, the introduction of live vaccines is excluded.

Features of the appointment for pregnant women and children

If there are absolute indications during pregnancy, a course of corticosteroids is possible, especially when eating future mom was in constant therapy. Preference should be given to natural corticosteroids without the addition of a fluorine group.

Hormones penetrate milk rather poorly, so the use of small doses during breastfeeding is not harmful. The use of higher dosages may cause growth and developmental disorders in the child. And also disrupt the work of the hypothalamus - the pituitary system, leading to endocrine disruptions.

For children, drugs are prescribed strictly according to indications, since long-term use of GCS leads to growth retardation. You can use nasal drops for allergic rhinitis or adenoids. The dosage of hormones in this form is minimal and does not cause systemic complications, moreover, only 4% of GCS is absorbed into the blood.

Side effects of corticosteroids

Undesirable effects occur when drugs are used for a long period at high dosages. Which exceed the physiological norms for the production of natural hormones. Also with abrupt withdrawal of drugs.

Modern schemes of introduction help to reduce the number of unwanted reactions. Inhalation administration is used, the replacement of systemic drugs with local ones (with not severe symptoms).

Steroids depress the immune system. Therefore, the most common complication is infection. Accordingly, the risk of attaching a virus or bacteria is greatly increased. Most patients suffer from pneumonia, but there are also cases of the development of serious forms of chickenpox (up to death). Therefore, patients are not recommended to communicate with those infected during course therapy, provided that they have not had chickenpox.

Complications

There are also a number of systemic complications:

1. Peptic ulcer - there is a risk of bleeding while taking it, especially when combined with non-steroidal anti-inflammatory drugs.
2. Weakness of the muscles - the muscles of the limbs usually suffer, and up to problems with walking and the cessation of motor activity. Long-term use in patients with bronchial asthma can cause myopathy of the respiratory muscles.
3. Cataract is a particularly high risk of development in children, therefore, with the introduction of 10-15 mg per day, it is recommended to periodically check the vision and consistency of the lens.
4. Mental disorders - usually insomnia, irritability, mood swings.
5. Osteoporosis - it develops in about 30 - 50% of patients who are on hormone therapy for a long time. Preparations have a particularly great effect on the bones of the ribs and spine. Usually, to reduce the negative effect of calcium loss, patients are prescribed 1500 mg of Ca + 400 mg of vitamin D. For a group of people with reduced secretion of sex hormones (including postmenopause), estrogens or testosterone are included in therapy.
6. Local skin changes - the most common complication is dry skin, thinning. The appearance of acne and stretch marks. Internal injections can cause atrophic changes in the skin and fatty tissue at the injection site.
7. Diabetes mellitus - corticosteroids cause significant changes blood formulas, as well as increased glycogen production by the liver.

The most serious complication is Itsenko-Cushing's syndrome, a disease associated with an increased concentration of adrenal hormones in the blood. The most common is the medicinal nature of the onset of the disease. The main symptoms are obesity (fat is distributed to the face, creating a round, moon-shaped face and abdomen, leaving thin limbs). Hormonal failure and a sharp weight gain is reflected in the appearance of huge stretch marks, possibly a profuse rash of acne.

There is an increase in blood pressure, excessive hair growth in women with a violation of the monthly cycle (up to amenorrhea), in men - impotence.

Syndrome "cancellation"

Not only long-term use of corticosteroids causes unwanted reactions. A sharp restriction of the intake of drugs in the body leads to the development of adrenal insufficiency.

Our body is quite lazy. If hormones (or other substances that he can produce himself) come from outside, then his own production is gradually slowed down. The patient has weakness, weight loss, depression of the central nervous system, lowering blood pressure.

To avoid such a reaction, therapy is carried out with a gradual decrease in dosage. If the insufficiency has already developed, then corticotropin is administered to neutralize.

List of drugs: table

Conclusion

What kind of drugs corticosteroids, from this material should be clear. Their action is equally beneficial as it is harmful. But they make life easier for many, including children. Therefore, you need to know as much as possible about him. Moreover, with proper treatment, on the recommendation of a doctor, it is replaced with safer drugs.

Take care of yourself and your loved ones!

Hormonal drugs of any group cause concern in patients. Many categorically refuse to take such drugs. Notoriety for all hormones earned precisely glucocorticoids (glucocorticosteroids). The problems of treatment with these medicines remain the focus of attention of doctors of all specialties today.

Problems of glucocorticoid treatment

The powerful anti-inflammatory effect of glucocorticoid drugs has led to the fact that they have become extremely widely used in various diseases in therapeutic practice. The reason for the appointment of these hormones can be both glomerulonephritis and viral hepatitis. In the body, steroids are produced in the endocrine glands - the adrenal glands. As medicines synthetic hormonal preparations are used. Most often, doctors prescribe Prednisolone, Cortisone, Hydrocortisone, Dexamethasone. These medicines can have a pronounced effect when administered by injection, in the form of tablets, and even topically (inhalations, ointments, suppositories). In any case, all these drugs have severe side effects. Another problem in the use of glucocorticoids is the need to gradually reduce the dose of the drug before canceling.

Side effects of glucocorticoid treatment

Treatment with drugs of this group leads to a variety of side effects. These include changes in appearance, thinning hair, overgrowth hair in women on the face and body, acne, thinning of the skin, stretch marks on the skin of the abdomen, bruising due to fragility of blood vessels. In large doses, steroids (glucocorticoids are steroids by structure) have a pronounced negative effect on the psyche of patients. Patients may develop anxiety, a decrease in the general background of mood, and in severe cases, an acute violation of the functions of higher nervous activity - psychosis. The gastrointestinal tract also suffers. The patient may develop a peptic ulcer. Severe complications can be from the musculoskeletal system. So it is possible to reduce growth and back pain from compression fractures, wasting and weakness of the thigh muscles. In people receiving glucocorticoids for a long time, immunodeficiency, arterial hypertension, and obesity may develop. Another problem can be reduced vision due to cataracts. Women may have dysmenorrhea. All these side effects are related to the dosage and duration of the drug, so they must be reduced to a minimum. In some patients, some of the manifestations may be barely noticeable.

Complications of glucocorticoid withdrawal

Long-term use of glucocorticoids in a large dose leads to the fact that the adrenal glands stop producing these hormones. The tissue of these endocrine glands gradually atrophy. In addition, the connection between the adrenal glands and the hypothalamic-pituitary system is lost. The mechanisms of their interaction are violated. As a result of all these processes, the adrenal glands lose their ability to adequately respond to the newly arisen need for their own hormones. Therefore, if a patient takes glucocorticoids for several weeks, and then refuses them one day, a serious life-threatening complication may develop. This is a complication. The main manifestation of this condition is a drop in blood pressure. Usually its numbers are much lower than 90/60 mm Hg. In addition, nausea, vomiting, and repeated loose stools often develop. Half of the patients develop severe pain along the intestines. The mental state of the patient also suffers. The patient may develop delirium, lethargy, stupor. Sometimes, due to cerebral edema, epileptic convulsions appear. To avoid acute adrenal insufficiency, glucocorticoids should be abolished gradually, reducing the dose weekly and only under the supervision of specialists.

Glucocorticoids are such drugs that only a specially trained specialist should prescribe. Self-medication with these hormones is absolutely unacceptable and poses a serious threat to life and health.