Re: [RPexec] Fwd: part 2

[Guest guest]

Both of these posts were sent to Lu from H. Thought you would all be interested.

Glucose Intolerance

High blood sugar, or steroid–induced diabetes. This usually resolves when the steroids are decreased or discontinued.

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Hypertension

High blood pressure. This usually improves as the corticosteroid dose is reduced.

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Increased Susceptibility to Infections

Patients are at increased risk for many types of infections, from minor fungal infections in the mouth (“thrushâ€, caused by Candida) to life–threatening infections such as Pneumocystis carinii pneumonia. The higher the steroid dose and the longer the duration of therapy, the greater the risk of infection. The risk is also increased when patients receive combinations of immunosuppressive medications, such as cyclophosphamide (cytoxan) and prednisone. The risk of some infections can be greatly reduced by taking specific types of antibiotics prophylactically.

Pictured below is woman under treatment with prednisone and methotrexate for vasculitis and a concurrent neurologic condition (myasthenia gravis) developed painful vesicles in her mouth. The vesicles were confirmed by culture to be caused by re–activation of a Herpes simplex infection, and responded to treatment with acyclovir.

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Bone Thinning (Osteoporosis)

Prednisone may cause thinning of the bones even in people who are not usually at high risk for osteoporosis (for example: males, young people). In people susceptible to osteoporosis, prednisone may accelerate the process of bone loss. Fortunately, in the past few years, excellent treatments and preventive measures have become available for osteoporosis. All patients on prednisone for prolonged periods are candidates for these medicines.

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Easy Bruising

Prednisone also causes “thin skinâ€. Patients on moderate to high doses of prednisone often notice that they bruise easily, even with only slight trauma. Pictured below is a patient with giant cell arteritis who suffered a skin laceration after she struck her leg against a chair.

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Mood Swings/Insomnia

Many patients find it difficult to sleep when taking high doses of steroids. Many also find that they are more irritable than usual. Steroids sometimes even induce depression, which improves when the drug is decreased or discontinued.

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Avascular Necrosis of Bone

For reasons that are not known, high dose prednisone (for example, greater than 20 milligrams a day) predisposes some patients to joint damage, most often of the hips. In avascular necrosis (or osteonecrosis, meaning “bone deathâ€) of the hip, the part of the leg bone that inserts into the pelvis dies, resulting in pain with weight–bearing and some loss of joint function. Many patients with avascular necrosis require joint replacements.

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Abdominal Striae

Abdominal striae (“stripesâ€), as pictured below, frequently occur in patients who take high doses of steroids for long periods of time.

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Cataracts

Long–term steroid use may lead to cataract development in the eyes, which frequently require surgical removal.

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Acne

High dose prednisone predisposes some patients to acne, especially facial acne, as pictured below. The facial acne developed after several weeks of high steroid doses.