The Prednisone Paradox: Are Corticosteroids Worth the Risk?

Posted on 30 June 2010

Cortisone—corticosteroids, glucocorticoids, Prednisone, etc—is used to treat over a hundred diseases, including—of course—rheumatoid arthritis. Prednisone and its cousins can cause dramatic improvement for those suffering from unmanageable flares and in some short-term cases, may be the only appropriate drug for treatment. Still, as anyone who has taken steroids can attest, this type of relief often comes at a very high price.

Disclaimer: Despite the unpleasant and even dangerous side effects of Prednisone et al, it is a legitimate, effective, and sometimes even life-saving drug. If you are currently taking Prednisone or some other form of steroids, please discuss your concerns with your rheumatologist. Please do not start, stop or modify your treatment without your doctor’s approval. Never stop steroid treatment suddenly or without notifying your doctor!

This article and the articles to follow are intended for informational purposes only and should not be considered medical advice. Any concerns or questions you may have about steroids or any other aspect of your treatment should be discussed with your doctor.

Note: Although steroids are available in dozens of different forms and brands, for simplicity’s sake, I will refer to the oral form of steroids as Prednisone.

Prednisone: The History
After serving as the Chief of Medical Service and Director of the Army’s Rheumatism Centre during World War II, Philip Showalter Hench returned to work at the Mayo Clinic and continued his twenty year research in rheumatoid arthritis and other autoimmune disorders. By the late 1940’s, it had become clear to Hench and others that in order to bring autoimmune diseases under control, it was necessary to suppress inflammation and the immune system. However, finding an effective agent remained elusive.

It was during this search that Hench began to notice a certain phenomenon among his patients. During pregnancy and in the presence of jaundice, the severe pain of rheumatoid arthritis decreased and in some cases, even disappeared. Hench, along with his colleague, Edward Calvin Kendall, began to consider the steroids of the adrenal glands as the endogenous substance “X” by which RA might be controlled and even cured, saying:

“Substance X…probably was a biologic compound specific in nature and function, one which was normal to the human organism and of which, perhaps, the arthritis patient did not have enough. Since pregnancy alters the concentrations of hormones, we began to suspect that substance X might be a bisexual steroid hormone.”

In 1948, Hench and Kendall tested their theory on a middle-aged woman afflicted with severe RA. After receiving a series of corticosteroid injections over several weeks, the woman’s symptoms disappeared and she got up and walked away from the bed in which she had been confined for several years.

Amazed by the results, Hench and Kendall treated other similarly affected patients. After only a few days, people who were so badly crippled that they couldn’t rise from a chair, shave, open a door or even lift a cup were walking and even dancing. Medical experts throughout the world hailed cortisone as a “miracle drug” and a cure for rheumatoid arthritis. Not surprisingly, P.S. Hench and E.C. Kendall were awarded the 1950 Nobel Prize in Physiology and Medicine.

By then, however, steroids were beginning to show its dark side. Patients taking cortisone in doses high enough to reduce inflammation were experiencing the now well-known side effects: increased appetite and weight gain; fat deposits in chest, face, upper back and stomach; water and salt retention leading to swelling and edema; high blood pressure; diabetes; osteoporosis; cataracts; acne; muscle weakness; thinning of the skin; increased susceptibility to infection; stomach ulcers; psychological problems such as depression; and adrenal suppression and crisis. In some cases, the cure became worse than the disease.

Prednisone Today

Despite the risk of dangerous side effects, however, cortisone treatment is still very much in use, simply because it is often the only effective drug available. Prednisone is used to treat hundreds of disorders, many forms of cancer, including leukemia; lupus, vasculitis, asthma, meningitis, ulcerative colitis,  allergies, tuberculosis, Myasthenia Gravis, dozens of skin disorders, including psoriasis; eye disease, pneumonitis, vasculitis, organ transplants (to prevent the body’s normal inflammatory reaction to foreign tissue and infection), and even autism.

Unfortunately, many people (and in some cases, doctors) have become so leery of “scare-oids” that they have refused much-needed treatment. And, while it is true that long-term use of Prednisone at high doses can cause serious side effects, when used judiciously, Prednisone can literally be a life-saver, especially when inflammation in the heart, lung, eyes and blood vessels are involved. A severe flare can cause extensive damage to joints and cartilage over time, but even in the most severe cases, Prednisone can often provide immediate relief.

Comments are closed.