Dr. Klippel on prednisone - reformatted (sorry!)

January 13, 2004

Here are some words of wisdom on corticosteroids like prednisone from

rheumatologist Klippel in a HealthTalk presentation:

Dr. Klippel:

Let me move to the second class, which is called corticosteroids or

glucocorticoids. Many patients take a drug called prednisone, typically

in lower doses. Again, what corticosteroids do is they reduce

inflammation, and in fact there's now I think rather clear evidence from

clinical studies that low doses of corticosteroids also appear to have

an effect in rheumatoid arthritis, somewhat unlike NSAIDs in that joint

destruction in people who take low doses of corticosteroids appears to

be lessened because of these drugs.

Now, the problem, and there are two with corticosteroids. In many

patients who begin to take corticosteroids, they take them for the rest

of their lives. That is, once patients start corticosteroids, it is

often very, very difficult to eventually wean the person away from

corticosteroids. And that becomes a problem because we recognize there

are many potential complications from corticosteroids, and they include

changes in weight. Oftentimes when people start corticosteroids, they

will gain weight. They will notice that immediately.

Over time, we're much more concerned about some other potential side

effects, and those too are many. They include an increased risk of

diabetes, the potential for cataracts, and the potential for

osteoporosis. So that in many ways, although corticosteroids are

helpful, there are many people who soon began to question whether the

side effects of corticosteroids are in fact much worse than the benefits

they might derive from the drug. So, although that category of drugs is

helpful, many people would question whether that's the ultimate solution

to rheumatoid arthritis.

Rick:

I'm curious, doctor. Why is it that it's very difficult to wean

yourself off corticosteroids?

Dr. Klippel:

Corticosteroids are fundamentally a natural hormone that all of us

make so that over time if we are substituting this hormone, what happens

is that the gland that ordinarily makes the hormone shrinks and no

longer has an ability to make it. And so that becomes a problem. As you

reduce the dose, the gland simply doesn't respond, and people can't make

the hormone.

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