Corticosteroids are powerful medications that reduce inflammation. Corticosteroids are given intravenously, orally, topically and through inhalers to treat a variety of conditions from asthma to rheumatoid arthritis. Long-term corticosteroid use has serious side effects and complications that rival some of the diseases it's used to treat. Corticosteroids should never be used long-term unless absolutely necessary, and only when the benefits outweigh the risks.
Corticosteroid Withdrawal
Corticosteroids must never be stopped abruptly after long-term use; the dose must be gradually tapered down. The adrenal glands, which normally produce cortisol, tend to shrink when cortisol-containing drugs are given and need time to slowly work back up to full production. If corticosteroids are suddenly decreased, adrenal insufficiency may occur. If you develop an infection during this time, the body may not have adequate resources to fight it off. Withdrawal from corticosteroids can also cause fever, nausea, vomiting, hypotension, hypoglycemia, muscle and joint pain and headaches, according to the eOrthopod website.
Bone Complications
Corticosteroids can have several serious effects on bone. Avascular necrosis, death of bone tissue, may occur along with osteoporosis, a decrease in bone mass caused by decreased calcium absorption. Bone pain and increased risk of fractures complicate corticosteroid use. Up to 50 percent of patients using corticosteroids long-term will have fractures, the DermNet website states. Calcium, vitamin D and bone-building medications such as bisphosphonates may be prescribed to help prevent bone loss. Children may have slowed growth while taking high doses of corticosteroids.
Infection
Infection due to immune suppression may occur both during and after corticosteroid use. Infections may escalate quickly because early symptoms are suppressed. This effect may continue for up to 12 months after corticosteroids are stopped, DermNet says.
Ocular Complications
Long-term corticosteroid use is related to the development of posterior subscapular cataracts (PSC), cataracts that form at the back of the lens capsule. Corticosteroid treatment can also raise the intraocular pressure (IOP) of the eye, and may cause glaucoma, damage to the optic nerve from increased IOP. Cataracts can develop from steroid eye drops or oral medications taken for 10 months to a year, the University of Illinois Eye & Ear Infirmary reports; short-term use does not usually result in cataract formation. Patients taking corticosteroids long-term should see an ophthalmologist regularly.
Psychological Changes
Corticosteroid use can cause mental changes, especially at high doses. Steroid-induced psychosis may occur; patients are manic, unable to sleep, impulsive and euphoric. Milder symptoms such as irritability, excitability, high energy levels and depression can occur.
Skin Changes
Corticosteroid use thins the skin and causes easy bruising. Acne is also common. Fat may be redistributed in the face, shoulders and trunk, leaving the arms and legs thin. Stretch marks often appear on the skin.
Other Complications
Long-term corticosteroid use can also result in gastrointestinal ulcers, diabetes, heart disease, fluid retention, headaches and weight gain.
