Prednisone is a generic, very inexpensive, and commonly used medicine in arthritis treatment.

The diseases for which corticosteroids are most often used are rheumatoid arthritis, lupus, psoriatic arthritis, polymyalgia rheumatica and temporal arteritis, polymyositis and dermatomyositis, gout and pseudogout, sarcoidosis, and the arthritis accompanying inflammatory bowel disease.

Ordinarily, endocrine glands in the body are responsible for the fine tuning of organ function. These glands elaborate hormones, all of which have specific regulatory tasks. Various feedback loops exert tight control over this very elaborate and complicated system.

One of the endocrine organs, the adrenal glands is responsible for the production of glucocorticoids.

Glucocorticoids have many "jobs" including maintenance of blood pressure, as well as sugar, protein, and fat metabolism, stress response, and effects on inflammation.

Glucocorticoids manufactured by the adrenal glands are called endogenous steroids- meaning they are made by the body. They also can be divided into anabolic or catabolic. Simply put, anabolic steroids build tissue such as muscle while catabolic hormones break down tissue.

Steroids can also be administered from outside the body either by mouth, intramuscularly or intravenously. These steroids are called exogenous. The administration of exogenous steroids chronically reduces the ability of the adrenal glands to manufacture glucocorticoids because the normal feedback loop has been broken.

With the inability of the adrenal glands to increase steroid production in the face of stress producers such as injury, infection, and surgery, a patient can go into shock.

Getting back to prednisone, the primary catabolic glucocorticoid, the odds of the adrenal glands being suppressed increase as the dose of exogenous steroid exceeds the average daily equivalent output of the adrenal glands which is about 5.0-7.5 mg prednisone. Other factors that constrain the ability of the adrenals to perform are if therapy continues for more than a few weeks or months, if doses are given late in the day or in divided doses throughout the day, or if long-acting corticosteroid preparations are used.

Patients who require high doses of prednisone (more than 20 mgs a day) for extended periods of time always develop side-effects.

Taking steroids on an alternate day (every other day) schedule reduces the chance of adrenal insufficiency but does not eliminate it.

Other side-effects include:

Elevated blood sugar and diabetes
Elevated cholesterol and triglycerides
Fluid retention
Increased blood pressure
Electrolyte abnormalities such as low potassium serum levels
Hardening of the arteries
Hirsutism (abnormal hair distribution)
Easy bruising
Thinning of the skin
Cataracts and glaucoma
Purple striae (stretch marks)
Poor wound healing
Muscle wasting
Susceptibility to infection and masking of infection leading to sepsis and death
Psychosis
Avascular necrosis (dead bone)
Sweating
Inflammation of the pancreas
Stomach ulcers (particularly if used with non-steroidal anti-inflammatory drugs)

Obviously, patients must be counseled as to the relative risks and benefits, and the lowest possible steroid dose should be used.

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