Tuesday, August 3, 2010

How to Minimize Side Effects of Long Term Steroid Use!

at Tuesday, August 03, 2010 Posted by Dr Prahallad Panda

Unfortunately, some patients need long term use of steroids for suppression of their diseases. One of such disease is systemic lupus erythematosus (SLE). Though, researchers know the process of the disease initiation, less is know what actually goes wrong. We label it as an auto-immune disease. There are many more auto-immune diseases. In SLE, the immune system of body does not recognise some of the tissue of body; thinking foreign, produces antibody against those. But, why that happens is less clear. These patients have to thrive on steroids and sometimes co-administration of immune suppressants.
Unfortunately, steroids save life but bring some unwanted changes in the body. There are many side effects of this drug. But, the important ones are:

Ulcer/inflammation of gastrointestinal tract, mainly duodenum and stomach.
Re-distribution fat, increasing it at some places like nape of neck.
Osteoporosis/osteopenia, loss/decrease of bone mass, due to calcium loss.
Stimulating cataract formation in the eye lens.
Proneness to infection, escalates a trivial infection as body immune system is at a lower level.
making muscles vulnerable to injury.
Delayed wound healing.

When taking steroid is inevitable, the target is to minimise the side effects as far as possible.

Lowest possible dose prescription. Co-prescription of immunosuppressants in a lower dose.
Use of newer steroids having less side effects in place of conventional ones. Those can be methylprednisolone and deflazacort etc.
Ulcerogenic side effects can be minimised by co-prescription of stomach acid inhibitors like H2 antagonists or proton pump inhibitors (PPIs).
Calcium and vitamin D supplementation. B group vitamin supplementation.
Taking hygienic measures may diminish the chances of catching infections.
Taking steps to prevent falls.
Taking adequate amount of protein and balanced diet.
Taking up physical exercise.
If eventually cataract develops, a minimally invasive cataract surgery can be undertaken.