Corticosteroids are a powerful and effective drug that widely used today in many fields of medicine [1] with injections, inhalers, sprays, pills and ointments.
In some cases, such as of severe asthma, life-threatening allergy, sepsis, [2] cerebral edema or cancer , it is a life-saving drug [3]; while in other cases such as psoriasis, arthritis, non-life-threatening asthma, atopic dermatitis, Crohn's, liver and kidney diseases ,it improves short-term quality of life. [4]
In addition, corticosteroids are found in the human body naturally. It is a component that is not foreign to the body.
So why not simply use steroids in chronic diseases? The answer consists of the following reasons:
1. The side effects of the drug are scanty and can be severe or irreversible in the long run [5][6].
2. The drug works by suppressing the immune system and leaves the body exposed and vulnerable to the new diseases [7].
3. The drug does not solve the source of the problem but only reduces the symptoms so that in many cases the symptoms reappear after stopping the drug [8].
4. The drug inhibits the body's natural healing process [9].
For example, injecting corticosteroids into a sore and swollen joint will reduce the swelling and pain but will interfere with the joint healing itself. It is very likely that arthritis will returns after a few months and may even worsen.
In many cases, the attending physician replaces corticosteroids with chemotherapy or biological therapy that have fewer side effects, but even with these treatments, today, there are still similar problems.
For these reasons the use of corticosteroids should be limited, compatible with the severity of the disease. Prolonged use may do more harm than good.
[1]Ericson-Neilsen W, Kaye AD. Steroids: pharmacology, complications, and practice delivery issues. Ochsner J. 2014;14(2):203-207 [2]Yue-Nan Ni, Yuan-Ming Liu, Yi-Wei Wang, Bin-Miao Liang, Zong-An Liang, Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis, The American Journal of Emergency Medicine, Volume 37, Issue 9,2019,Pages 1657-1664, ISSN 0735-6757,
[3]Dietrich, Jörg, et al. "Corticosteroids in brain cancer patients: benefits and pitfalls." Expert review of clinical pharmacology 4.2 (2011): 233-242.
[4]D.J. Maselli, J.I. Peters Medication regimens for managing acute asthma Respir Care, 63 (2018), pp. 783-796
[5]Fardet L. , Kassar A. , Cabane J. , et al. Corticosteroid-induced adverse events in adults: frequency, screening and prevention. Drug Saf. 2007; 30: 861-881
[6]Cosman F, Nieves J, Herbert J, Shen V, Lindsay R. Highdose glucocorticoids in multiple sclerosis patients exert direct effects on the kidney and skeleton. J Bone Miner Res 1994; 9: 1097-105.
[7]Hatice Ezgi Baris, Safa Baris, Elif Karakoc-Aydiner, Ibrahim Gokce, Nurdan Yildiz, Dilek icekkoku, Ismail Ogulur, Ahmet Ozen, Harika Alpay , Isil Barlan The effect of systemic corticosteroids on the innate and adaptive immune system in children with steroid responsive nephrotic syndrome European Journal of Pediatrics volume 175, pages 685–693 (2016)
[8]Papi, Claudio M.D.1; Festa, Virginia M.D.1; Leandro, Gioacchino M.D.2; Moretti, Alessandra M.D.1; Tanga, Monica M.D.1; Koch, Maurizio M.D.1; Capurso, Lucio M.D.1 Long-Term Outcome of Crohn's Disease Following Corticosteroid-Induced Remission, American Journal of Gastroenterology: April 2007 – Volume 102 – Issue 4 – p 814-819
[9]Wicke C, Halliday B, Allen D, et al. Effects of Steroids and Retinoids on Wound Healing. Arch Surg. 2000;135(11):1265–1270. doi:10.1001/archsurg.135.11.1265