(also known as glucocorticoids, corticosteroids, prednisone, hydrocortisone, betamethasone, budesonide)
Used to treat moderate and severe attacks of inflammatory bowel disease (IBD), steroids reduce inflammation more powerfully and more effectively than the 5-ASA drugs. Steroids are derived from cortisol, a natural steroid produced by the adrenal glands. These are not the same as the steroids used by athletes (anabolic steroids).
Steroids may have a number of side effects:
Visible effects: Steroids may cause rounding ("moon face") and/or redness of the face, hair growth on the face, acne, and stretch marks. In children, reduced growth rate or delayed puberty may result. In malnourished patients, the ankles may swell because of increased fluid in the body since steroids cause fluid retention. In long-term users a fatty deposit may form in the middle/upper back ("buffalo hump"). Muscle weakness in the thighs and upper arms can occur (muscle wasting). Patients on steroids often develop increased appetite and weight gain; increased energy and less need for sleep. Night sweats are also possible. Many of these changes are not dangerous and most will gradually disappear when the course of steroids is completed. Nonetheless, they can be very disconcerting to patients and their families.
Invisible effects: Softening of bones (so they break more easily) and joint degeneration may be seen in patients who take large doses for long periods of time. Thinning of the skin in arms and legs leads to fragility of the skin. Veins may become more easily damaged, leading to an increased tendency to bruise. Increased blood sugar can aggravate diabetes. Reduced potassium levels, increased eye pressure, cataracts, and peptic ulcers may also occur.
Psychological effects: Steroids can change people's moods: they may feel more energetic, have more appetite, and put on weight. They may also become depressed. Some people may feel nervous or "jittery." Even coming off steroids may trigger changes in mood.
Overall, this list of side-effects looks pretty horrible. So why are steroids used in IBD? Because they can be dramatically effective in reversing a serious bout of inflammation and providing time for the patient to settle and alternative treatment plans to be made.
Important steroid use warning: When people take steroids, their adrenal glands slow down, or completely stop producing normal cortisol (since the body senses the administered steroids and figures it does not need to produce any of its own!). When people stop taking steroids - and most prescriptions are only temporary, not for continuous use - it takes some time for the adrenal glands to "kick in" again and resume producing cortisol. If the steroid medications are stopped suddenly, there may be a period of some days where the body is unable to produce an adequate level of cortisol on its own since the adrenal glands take a little while to switch back on.
Cortisol is a stress hormone and an inability to produce the required amount of cortisol in times of stress or illness can be dangerous. Some of the indications that a person is not producing enough cortisol naturally are: nausea, fatigue, weakness, light-headedness, and diarrhea. In patients with an ileostomy, significant loss of watery fluid from the ileostomy may result if cortisol levels are low. The person's doctor should be informed of a possible cortisol deficiency and an extra amount of steroids may have to be given until the adrenal glands resume their natural production capability. It is important, therefore, that a person who has taken steroids for even a few days seek professional guidance on how they should best be stopped. Usually, the physician will recommend a program of tapering the dosage down to a gradual stop. Never stop steroids "cold turkey" if they have been taken by mouth or intravenously.
People with Crohn's disease may need to take steroids continuously to control chronic symptoms. This occurs less commonly in ulcerative colitis, where steroids are only taken until symptoms abate, then they are tapered off and gradually stopped. In general, patients with ulcerative colitis who are required to take steroids continuously (more than 3 months) should really be considered for surgery in order to allow them to get off the medications. This is because, in the final analysis, ulcerative colitis can be cured surgically and the surgery may be better than accepting the long term side effects of continued steroid usage. The situation is not so clear for those with Crohn's disease, since surgery is not always a good option.