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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 Drug dosage must be tapered over time in order to allow the adrenal cortex to start producing the hormones that have been replaced by the drug.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

Clinical Outcomes of Myocarditis after Moderate-Dose Steroid Therapy in Systemic Sclerosis (SSc): A Pilot Study. Moderate-dose steroid therapy may improve myocarditis in SSc, although a proportion of patients died due to cardiac complications during treatment. PubMed, Int J Rheumatol, 2020 Dec 19;2020:8884442.

Glucocorticoids and antimalarials in systemic lupus erythematosus: an update and future directions. In moderate-severe flares, pulse methyl-prednisolone are more effective and much less toxic than increasing the oral doses of prednisone. PubMed, Curr Opin Rheumatol, 2018 Sep;30(5):482-489. (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.

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.

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) improves fracture risk assessment in glucocorticoid-induced osteoporosis. TBS seems to have greater discriminative power than BMD for fracture risk assessment in GC-treated patients, confirming the utility of this method as a complementary tool in the diagnosis of GC-induced OP. PubMed, Rheumatology (Oxford), 2020 Jul 1;59(7):1574-1580. (Also see Osteoporosis and Scleroderma)

Renal Crisis

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

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. (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. (Also see Atherosclerosis)

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