Corticosteroids are very powerful medicines. They help to control or turn off inflammation quickly. They do this by acting on the immune system. Corticosteroids work much faster than the slower acting NSAIDs. Corticosteroids can improve JIA symptoms in as little as 48 hours.
What are corticosteroids?
Corticosteroids are often called steroids. However, the word steroid can be confusing. Corticosteroids are very different from the steroids some athletes take to do better in their sport.
Corticosteroids are hormones produced naturally by the body. One corticosteroid in the body is called cortisone. Corticosteroids are important for body metabolism. This means they help the body convert the food we eat into the energy we need to do things.
Corticosteroids work much faster than the slower acting NSAIDs. Corticosteroids can improve JIA symptoms in as little as 48 hours.
What are the side effects of corticosteroids?
Corticosteroids may have more side effects than NSAIDs. They can affect almost every type of tissue and organ in the body. Corticosteroids are not commonly used in young people with JIA. If your child needs to take corticosteroids, their doctor will use the smallest dose for the shortest period of time.
Corticosteroids may be used for:
- children and teenagers with severe JIA who need treatment while waiting for other medications to start to work
- children and teenagers with systemic JIA
- rarely in children and teenagers where other medications have not worked.
Types of corticosteroids
The following are corticosteroids commonly used to treat JIA. Two of these are given orally, and one is given by IV. Prednisone is the most commonly used oral corticosteroid in the treatment of JIA.
Prednisone
Most common brand name: Prednisone
How it is given: By mouth, one to three times daily
How the medication comes: Liquid or pill
Side effects
Early side effects:
- Increased appetite
- Stomach ache or burning, nausea
- Trouble sleeping, mood changes
Late side effects:
- Weight gain, puffy face, acne, increased body hair and stretch marks
- Stomach ache or burning, nausea
- Trouble sleeping, mood changes
- Changes in menstrual pattern
- May reduce the activity of the immune system and you may see more frequent infections
- Fluid retention/swollen feet and/or ankles
- High blood pressure
- Cataract formation
- High blood sugar (increased thirst frequent urination)
- Reduced blood flow to bone causing bone softening (avascular necrosis)
- Osteoporosis (fractures, back or rib pain)
Prednisolone
Most common brand name: Pediapred
How it is given: By mouth, one to three times daily
How the medication comes: Liquid
Side effects
Early side effects:
- Increased appetite
- Stomach ache or burning, nausea
- Trouble sleeping, mood changes
Late side effects:
- Weight gain, puffy face, acne, increased body hair and stretch marks
- Stomach ache or burning, nausea
- Trouble sleeping, mood changes
- Changes in menstrual pattern
- May reduce the activity of the immune system and you may see more frequent infections
- Fluid retention/swollen feet and/or ankles
- High blood pressure
- Cataract formation
- High blood sugar (increased thirst frequent urination)
- Reduced blood flow to bone causing bone softening (avascular necrosis)
- Osteoporosis (fractures, back or rib pain)
Methyl-prednisolone
Most common brand name: Solu-Medrol
How it is given: Intravenously
How the medication comes: Injectable
Side effects
Early side effects:
- Increased appetite
- Stomach ache or burning, nausea
- Trouble sleeping, mood changes
Late side effects:
- Weight gain, puffy face, acne, increased body hair and stretch marks
- Stomach ache or burning, nausea
- Trouble sleeping, mood changes
- Changes in menstrual pattern
- May reduce the activity of the immune system and you may see more frequent infections
- Fluid retention/swollen feet and/or ankles
- High blood pressure
- Cataract formation
- High blood sugar (increased thirst frequent urination)
- Reduced blood flow to bone causing bone softening (avascular necrosis)
- Osteoporosis (fractures, back or rib pain)
Important safety points about taking corticosteroids
- Stomach upset can frequently be avoided by taking the medication with food. If your child continues to have stomach aches with this medication, their doctor may prescribe a medication to help protect their stomach. One of the rare side effects of corticosteroids is stomach ulcers. Signs of an ulcer may include vomiting blood or passing a bloody or black stool. If this occurs, your child should see their doctor immediately.
- If your child has a fever, chills, or other symptoms of infection, see your doctor as soon as possible.
- Your child should not take live vaccines (MMR, varicella) while taking steroids.
- If your child has not had chicken pox and is exposed to someone who has chicken pox, contact your child's doctor as soon as possible.
- If your child takes a corticosteroid medication for a prolonged period of time (more than three months), they should wear a Medic-Alert bracelet or necklace (see www.medicalert.ca). If your child is in an accident or needs surgery, the emergency medical personnel will know that your child needs extra medication. Your child's body needs extra cortisone during these times.
It is important to speak to your child's doctor about the side effects of corticosteroids. Your child may not like taking corticosteroid medication because of its side effects. In fact, they may feel like stopping it. However, corticosteroids should never be stopped suddenly. They should be gradually reduced according to the doctor’s instructions. This allows the body to start producing its own corticosteroids again. Stopping corticosteroids too quickly can lead to serious side effects. Remember, talk to your child's doctor or nurse about any concerns you and your child might have about taking corticosteroids.
Tips for managing side effects of oral corticosteroids
It is hard to take a medication that can change the way you look. The changes will depend on how much corticosteroid your child needs to get better. If your child's face gets rounder, remind them that this will go away when their dose is lowered. The toughest part for most teenagers is the increased appetite. Here are a few tips for managing the side effects of corticosteroids.
- Take the corticosteroids with food. Try taking pills with breakfast, lunch or dinner. If your child needs to take their medications at school, have them carry a small snack with them.
- Eating right and staying active will help to minimize side effects such as weight gain, osteoporosis, increased cholesterol, and changes in blood pressure. The rheumatology health care team can help to review your child's diet. They may suggest avoiding too many salty, fatty and sugary foods.
- Corticosteroids can make bones weaker. Your child can help reduce this by taking in enough calcium and vitamin D in their diet along with staying active. They may need to take vitamin supplements. Talk with your child's doctor or nurse about how much your child should take.
- To minimize acne, have your child wash regularly with soap and water. If that does not help, speak to your child's doctor about other lotions that help to control acne caused by corticosteroids.
- To help with stretch marks, try to maintain a healthy diet. Avoid excessive sun exposure to the stretch mark or use extra sun protection. Apply vitamin E to the stretch mark.
