Article Surfing Archive

Corticosteroids are potent anti-inflammatory drugs which are commonly used for a number of medical conditions. They are a mainstay of treatment for many forms of arthritis, particularly rheumatoid arthritis.

While they are extremely effective for reducing inflammation, they also have numerous potential side effects.

These include osteoporosis, cataracts, thinning of the skin, an increased tendency for the development of peptic ulcer disease, suppression of the adrenal glands, depression and mood changes, osteonecrosis (dead bone), inflammation of the pancreas, moon face, weight gain, diabetes, striae (striped discoloration of the skin), and so on.

A recent study has demonstrated another potentially lethal side effect. Corticosteroids and immunosuppressive disease-modifying anti-rheumatic drugs (DMARDs)appear to contribute to a marked increase in risk of serious infection in patients with rheumatoid arthritis (RA).

Corticosteroids, usually in the form of prednisone, are often prescribed along with methotrexate in the treatment of active RA.

To assess the risk, researchers conducted a case-control study looking at a total of 23, 733 patients with RA. Light">All patients had received at least one DMARD, including biologic agents although the use of biologics started in 2002 and the patients evaluated were studied from 1980 to 2003. The patients were compared to controls.

The investigators determined that patients who received either cyclophosphamide (a very potent DMARD which is not commonly used anymore) or corticosteroids had a substantial risk of infection compared with controls.

When the period of time when anti-TNF drugs were used, there also was a signal that anti-TNF drug use was also associated with an increased rate of infection.

The authors concluded that careful attention to risk of infection is needed now more than ever because of the use of new emerging therapies. It is still unclear whether combinations of drugs that include corticosteroids will increase the risk of infection even more. (Bernatsky S,et al. Rheumatology. 2007; 46:1157-60).

It is important that a patient with RA who is taking corticosteroids be aware of this potentially dangerous problem.