Cortisone

Last updated: Tuesday, December 09, 2008 Print

Systemic cortisone therapy involves corticosteroid tablets taken orally, or injections into the muscle or bloodstream.

Cortisone is used in rheumatoid arthritis, when simpler medication has failed, or in the treatment of injuries to reduce swelling and inflammation.

The use of systemic cortisone (taken as tablets or injected into the muscle or bloodstream) can suppress the adrenal glands’ own cortisone production, and this can lead to a whole range of side-effects one would prefer to avoid in the long term.

Cortisone’s effect on the body

It reduces redness, swelling and inflammation, and it suppresses the immune system if taken in high dosages.

Prednisone is the most commonly used steroid tablet for people with rheumatic diseases.

Who can benefit from steroid tablets?

1. Steroids can very effectively relieve the symptoms of swelling, redness and inflammation in people with rheumatoid arthritis, systemic lupus erythematosus (SLE), in the treatment of polymyalgia rheumatica and temporal arteritis and polymyositis.
Rheumatologists recommend the use of oral corticosteroids in cases of severe synovitis not responding well to NSAIDs.
Elderly frail RA-sufferers with ongoing synovitis and who are not suitable for disease-modifying anti-rheumatic drug (DMARD) use.
Ankylosing spondylitis does not respond well to cortisone.
Not routinely recommended for osteoarthritis.

They act by suppressing disease activity; prednisone does not cure rheumatic disease. Cortisone is no cure.

When do I take prednisone?

Prednisone is usually taken in the morning. Coated tablets should not be chewed but swallowed whole.

What dose do I take?

The dose will depend on your disease and your body weight. The use of oral corticosteroids for RA is usually limited to 10 mg daily, for up to 6 months. You will be weaned off your steroid tablets slowly, to make sure you body’s own cortisone production is controlled.

How long will steroids take to work?

You will notice a benefit within ten days.

What are the possible side-effects?

The longer you are taking prednisilone and the higher the dose, the higher your risk of side-effects. This is why the lowest possible dose is prescribed to keep your disease under control.

Side-effects may include:

weight gain
a round moon face
thinning of the bones (osteoporosis) and skin
indigestion
bruising
stomach pains
muscle weakness
mood swings
cataracts
Your blood glucose sugar level may rise.
If you have diabetes you may require a change in the treatment of your diabetes.
If you suffer from epilepsy, then it is possible that prednisone could make the epilepsy worse.
Prednisone can also make glaucoma worse.
Taking prednisone can also suppress your immune system and make you more likely to develop infections. If this happens or if you have a fever you should report to your doctor. Signs of infection can be disguised by prednisone. So if you feel unwell or develop any new symptoms after starting prednisolone, it is important to tell your doctor.
High doses of prednisolone can cause a rise in blood pressure.
If you have not had chicken-pox but come into contact with someone who has chicken-pox or shingles, you should report to your doctor immediately as you may need special treatment. If you develop chicken-pox or shingles you should report to your doctor immediately.
In children, taking steroids can suppress growth. However, some of the conditions for which steroids are prescribed can also affect growth.

What about interaction with other medication?

Some drugs can interact with cortisone. Avoid immunisation injections which involve live vaccines such as polio, rubella (German Measles) and yellow fever. Flu vaccines are safe and recommended. Most drugs can be safely taken with cortisone.

Do cortisone tablets affect pregnancy?

It is best not to take cortisone during pregnancy. If you fall pregnant while on cortisone therapy, consult your doctor. Never stop cortisone tablets abruptly.

What about alcohol while taking cortisone tablets?

Both can upset the stomach. Alcohol should be avoided.