From skin rashes to sinusitis, corticosteroids are regularly prescribed to address a range of health issues.

But while these steroids may bring much-needed relief, they can cause a host of side effects, such as osteoporosis, weight gain, eye issues, and even heart disease and diabetes.

Dr. Nicole Cotter, a rheumatologist at UCHealth Rheumatology Clinic in Steamboat Springs, outlines what you need to know about steroid use below.

How do steroids work?

Corticosteroids are medications that act like cortisol, a hormone naturally released by the adrenal gland when you’re injured or stressed. Similar to cortisol, corticosteroids such as prednisone and methylprednisolone can slow or stop immune system processes that trigger inflammation.

Corticosteroids aren’t the same as anabolic steroids, which are a synthetic form of testosterone that may be taken to increase muscle mass.

What are the uses for steroids?

“In rheumatology, we treat inflammation and the diseases that cause it, and steroids are potent anti-inflammatory drugs,” Cotter said. “We’ll often use them to decrease inflammation with the idea of inducing remission.”

Steroids are helpful in a range of conditions, such as rheumatoid arthritis, lupus, multiple sclerosis, asthma and skin conditions.

A short course of steroids may be prescribed to calm joint inflammation, while higher doses of steroids may be given over longer periods of time to manage more critical illnesses, such as systemic vasculitis.

In many cases, steroids are necessary, for instance if inflammation has increased enough to damage a patient’s organs.

“When a disease is dangerous and potentially organ-threatening, we use steroids to knock it out,” Cotter said.

What are common side effects of steroid medications?

While steroids are powerful medications, those benefits can come at a price.

“The side effect profile of steroids is one of the most alarming of any medication, in part because the side effects of steroids are guaranteed,” Cotter said. “The list of side effects goes on and on. They’re not good long-term medications.”

Patients may be surprised and frustrated by immediate side effects, such as weight gain, puffiness, insomnia and mood changes. If steroids are used for a long period, additional side effects may arise. For instance, a patient may suddenly break a hip and learn that they have osteoporosis.

Steroids require an endgame

With any steroid usage, it’s critical to begin with the end in mind.

“Whenever I prescribe steroids, we’re talking about the endgame and what the plan is for getting someone off steroids,” Cotter said. “I will tell people from the very beginning about steroid withdrawal, so they’re not caught off guard.”

It’s of top importance to taper down steroid usage when the prescribed course is ending.

“Steroids make people feel good. If you’ve been on them for a long period of time, then you have to taper them down,” Cotter said. “If you stop steroids abruptly, that’s when you can get sick and go through withdrawal.”

While tapering down steroid dosages, patients may find issues such as arthritis pain resurface. That can require some careful sleuthing to determine treatment.

“The arthritis pain is unmasked, and people think the disease is flaring up,” Cotter said. “We have to tease out what truly is the disease flaring versus steroid withdrawal and determine if we need to re-up the steroid usage or put something else in place.”

Steroids should be used only when necessary

In all instances, it’s important to use steroids only when necessary, and to opt for the lowest dose required for as short of a period of time as possible.

“Just as we talk about stewardship with antibiotics, we should be using steroids judiciously,” Cotter said. “There are times you absolutely need them and should take them, and we know there are side effects, and we will monitor for them, but we’re not just using them because they can make people feel better.”

What are some additional side effects of steroid use?

Corticosteroids can play a critical role in treating and managing a host of diseases, but they can result in a range of side effects, including steroid-induced adrenal insufficiency.

“If you take a corticosteroid for long enough at a high enough dose, your body thinks, ‘I don’t need to make my own steroid,’” said Dr. Jessica Devin, an endocrinologist at UCHealth Endocrinology Clinic in Steamboat Springs. “There’s reduced signaling from the pituitary gland to the adrenal gland, and over time, the adrenal gland makes less.”

Adrenal insufficiency may occur when patients take steroid dosages that reach the level the body naturally makes, such as 10 mg or higher of prednisone. While past research suggested adrenal insufficiency wasn’t usually an issue until after steroids were used for several months, newer research suggests the condition can crop up sooner.

“Some of the more recent data says we need to start thinking about adrenal insufficiency even after a month,” Devin said.

Taking steroids for longer periods at higher doses, or using long-lasting steroids, can be more likely to cause steroid-induced adrenal efficiency, but some people experience impacts after a shorter course of lower-dose steroids.

“There are all sorts of genetic and clinical modifiers, many of which we don’t completely understand,” Devin said. “Some people can hop on and off these medications and be fine, while other people run into a problem even when they haven’t been on them as long.”

Symptoms of steroid-induced adrenal insufficiency can be general and diffuse, and include nausea, fatigue and an overall feeling of achiness.

Because symptoms are so general, some patients only learn they have the condition when they’re in the hospital for another issue. For instance, someone who has used steroids for asthma may go to the hospital for a surgery, then learn they have low blood pressure. A quick check of the patient’s cortisol level may reveal steroid-induced adrenal insufficiency.

If symptoms of the condition arise in people who have a history of steroid use, Devin recommends checking morning cortisol levels. If the value is less than 10, a treatment plan is created, and cortisol levels are re-checked.

If the cortisol level is persistently low, Devin recommends seeing an endocrinologist for further evaluation.

Tapering steroid usage is critical in preventing and addressing steroid-induced adrenal insufficiency.

“You want to taper off of it, as that enables the pituitary gland and adrenal gland to acclimate and start waking up with the signaling of hormones,” Devin said.

While steroid-induced adrenal insufficiency can be frustrating, the good news is that it can be treated. Often in treatment, a patient is prescribed another course of a steroid, but this time a shorter-acting steroid such as hydrocortisone may be used. Then, the steroid can be slowly tapered, sometimes over several months.

With all steroid usage, it’s important not to self-dose. It’s common to experience symptoms of steroid-withdrawal when reducing steroid usage, but eventually those symptoms resolve. Staying on steroids may help someone avoid symptoms of withdrawal, but it ultimately prolongs recovery.

“One of the main frustrations for patients is there’s no treatment for steroid withdrawal,” Devin said. “But we can acknowledge that at least we have a label and an explanation for it. It’s not a forever thing. It’ll get better. But unfortunately, you’ve got to stick it out.”