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Glucocorticoids, Steroids (Prednisone) Warnings for Scleroderma

Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases

Author: Janey Willis. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Use with Autoimmune Diseases
General Side Effects
Weight Gain
Osteoporosis
Renal Crisis
Additional Risks

Overview

Corticosteroids strongly increase the short-term risk of developing scleroderma renal crisis!

Glucocorticoids are any of a group of steroid hormones, such as cortisone, that are produced by the adrenal cortex and are involved in carbohydrate, protein, and fat metabolism.

Glucocorticoids have anti-inflammatory properties. They can be prescribed to dampen or stop the chronic inflammatory chain of events. Depending on the particular glucocorticoid that is used, inflammation can be affected at different points in the inflammatory pathway.

Glucocorticoids and steroids should never be stopped suddenly. Drug dosage must be tapered over time in order to allow the adrenal cortex to start producing the hormones that have been replaced by the drug. Always follow your doctor's tapering schedule when coming off these drugs.

Corticosteroids (such as prednisone) strongly increase the short-term risk of developing scleroderma renal crisis (kidney failure). It also causes a 70 percent increased risk of developing pneumonia.

It is crucial to avoid corticosteroids in patients with systemic scleroderma. (Also see What is Scleroderma?, Medical Overview, and Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases)

Scleroderma Treatments and Clinical Trials ISN.

Use of Glucocorticoid, Steroids (Prednisone) with Autoimmune Diseases

Adrenal crisis while on high-dose steroid treatment: what rheumatologist should consider? We present a patient who developed adrenal crisis while receiving high–dose methylprednisolone treatment due to retroperitoneal fibrosis. PubMed, Rheumatol Int, 11/01/2016.

Outcome of a glucocorticoid (GC) discontinuation regimen in patients with inactive systemic sclerosis. Disability as assessed by Health Assessment Questionnaire Disability Index (HAQ–DI) was the leading factor hindering GC discontinuation, as a low HAQ–DI score can identify candidates for GC discontinuation. PubMed, Clin Rheumatol, 2016 Aug;35(8):1985-91.

Assessment of Risks of Pulmonary Infection During 12 Months Following Immunosuppressive Treatment for Active Connective Tissue Diseases: A Large-scale Prospective Cohort Study. Physicians should be aware of the higher risks for corticosteroids of pulmonary infection than other immunosuppressants and assess these risk factors before immunosuppressive treatment. PubMed, J Rheumatol, 02/01/2015. (Also see Immunosuppressants)

Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus (SLE). Prednisone causes damage in SLE, but doses less than 7.5 mg/day and methylprednisolone pulses are not associated with damage accrual. PubMed, Rheumatology (Oxford), 2014 Mar 27. (Also see Systemic Lupus Erythematosus)

Scleroderma Overlap Syndrome. The definition of scleroderma overlap syndrome is important, especially in patients who need high dose corticosteroids for complications of a connective tissue disease (CTD). The use of novel biological therapies may be advocated in these patients to avoid the hazardous influences of high-dose steroids, especially renal crisis. PubMed, Isr Med Assoc J, [2011]. (Also see Scleroderma Overlap)

General Side Effects of Glucocorticoid, Steroids (Prednisone)

Prednisone Side Effects include hirsutism (excessive body hair), weight gain, undesirable redistribution of body fat (buffalo hump and fat pads), glucose intolerance, hypertension, increased susceptibility to infection, bone thinning, easy bruising, mood swings, insomnia, avascular necrosis of bone, abdominal striae (stretch marks), cataracts, and acne. The Johns Hopkins Vasculitis Center.

Fear keeps many eczema patients from using steroid creams. Many people with eczema may avoid creams and ointments that can help ease symptoms like itching and inflammation because they’re afraid to try topical corticosteroids, a recent study suggests. Reuters Health, 07/26/2017.

Steroids May Be Risky Even in the Short Term. The dangers of long–term use of corticosteroids like prednisone and cortisone are well known, but a new study suggests that even short–term use can have serious side effects. New York Times, 04/18/2017.

Weight Gain

Prednisone Weight Gain. Weight gain is usually the most dreaded side-effects of steroid use, incurred to some degree by nearly all patients who take them. In addition to causing weight gain, prednisone leads to a redistribution of body fat to places that are undesirable, particularly the face, back of the neck, and abdomen. The John Hopkins Vasculitis Center.

Will the weight I gained while taking prednisone ever go away? Prednisone causes the body to retain sodium (salt) and lose potassium. This combination can result in fluid retention, weight gain, and bloating. Measures that can be used to avoid fluid retention in the first place are eating a reduced sodium diet and increasing potassium intake through potassium-rich foods (such as bananas, cantaloupe, grapefruit, and lima beans). VeryWell.

Osteoporosis

Trabecular Bone Score (TBS) in Female Patients with Systemic Sclerosis (SSc): Comparison with Rheumatoid Arthritis and Influence of Glucocorticoid (GC) Exposure. SSc-related bone involvement is characterized by an impairment in bone quality in addition to reduced bone quantity, and TBS can identify the negative effect of GC on bone microarchitecture. PubMed, J Rheumatol, 12/01/2014. (Also see Osteoporosis and Scleroderma)

Increased risk of osteoporotic fractures in patients with systemic sclerosis (SSc): a nationwide population-based study. SSc patients had a high increased risk of vertebral and hip fractures, especially those who were female, older, or used a high dose of corticosteroid (> 7.5 mg) or experienced bowel dysmotility. PubMed, Ann Rheum Dis, 2014 Feb 14. (Also see Osteoporosis in Scleroderma)

Renal Crisis

Corticosteroids strongly increase the short-term risk of developing scleroderma renal crisis!

Corticosteroids (CS) in Myositis and Scleroderma. The extracutaneous features of systemic sclerosis are frequently treated with CS; however, high doses have been associated with scleroderma renal crisis in high-risk patients. Rheumatic Disease Clinics, 10/27/2015.

Scleroderma Renal Crisis. SRC occurs in about 10% of all patients with scleroderma. It is characterized by malignant hypertension and progressive renal failure. Around 10% of SRC cases may present with normal blood pressure. Risk factors include rapid skin thickening, use of corticosteroids or cyclosporine, new-onset microangiopathic hemolytic anemia and/or thrombocytopenia, cardiac complications, large joint contractures, and presence of anti-RNA polymerase III antibody. Semin Arthritis Rheum, 2015 Jun;44(6):687-694. (Also see Scleroderma Renal Crisis)

Additional Risks

Steroid Use in Patients with Rheumatoid Arthritis and Risk of Myocardial Infarction. Beyond the usual gamut of adverse effects generally linked with use of glucocorticosteroids (GCs), a recent study found these agents to be associated with nearly a 70% increased risk of myocardial infarction (MI) in patients with rheumatoid arthritis (RA). Pharmacy Times.

Clinical and subclinical atherosclerosis in systemic sclerosis: consequences of previous corticosteroid treatment. Our study confirms an increased prevalence of subclinical atherosclerosis in SSc patients and demonstrates a hitherto unknown association with corticosteroid cumulative dosage. Scand J Rheumatol, [2010]. (Also see Atherosclerosis)

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