STEROID TREATMENT FOR INFLAMMATORY DISORDERS
Steroid is an abbreviation for "adrenal corticosteroid" a
group of chemicals secreted into the blood (hormones) by the adrenals,
two small glands which lie in the abdomen just above the kidneys. Steroids
have important functions in the body including in part regulating the control
of blood sugar and resistance to stress.
Indications for treatment:
Treatment with steroids can be needed either be needed for replacement
of the natural chemicals if the adrenal glands for some reason fail to
work normally (usually referred to as steroid replacement, see the sheet
on this) or, in larger doses, they have extremely useful properties in
reducing inflammation. They are therefore widely used in the treatment
of inflammatory diseases such as arthritis and asthma and in diseases in
which the immune system is at fault such as nephrotic syndrome.
Steroid drugs:
For replacement the naturally secreted hormone hydrocortisone, given
twice or three times a day, is generally used but for treatment of inflammation
the more potent synthetic steroid, prednisolone, given oncea day or on
alternate days, is preferred. The dose required varies greatly but doses
of hydrocortisone greater than 20mg daily and doses of prednisolone greater
than 5mg daily give blood levels higher than the normal secretion of the
adrenals and have the effect of turning off the secretion of steroids from
the adrenal glands.
Side effects:
The beneficial effects of steroids are unfortunately associated with
a wide variety of possible side effects. In children one of the most important
is slowing of growth, fortunately there is "catch-up" growth
when the treatment is stopped. There is also an increase in appetite and
gain in weight with most of the weight distributed around the middle and
especially visible in the cheeks, which can eventually cause the typical
"moon face".
Most children on steroids show some cahange in mood, they often become
rather "high" initially but this usually improves quickly.
Steroids may also cause indigestion by irritating the stomach, increase
the blood pressure and in the olonger term cause thinning of the bones.
There are many other possible side effects but fortunately these are only
seldom seenin children.
Dosage schedules:
The tablets should be taken during or after eating to reduce the irritant
effect. In children, if it proves sufficient to control the disease, it
is preferable to give steroids in a single dose on alternate days only,
i.e. with a 48 hour gap between doses. This allows the adrenal glands to
recover between doses and prevents their becoming suppressed. However,
with more acute illness it is often necessary to give twice daily dosage.
When it is possible to reduce the dose of steroid this should be done slowly
over a matter of weeks, if necessary reducing the dose by only 1 or 2.5mg
each week.
Precautions:
The most important instruction is not to stop the tablets suddenly at
any time. The dose should be doubled to cover any serious illness, stress,
or accident. Most important of all, if the steroid dose is repeatedly vomited,
it must be given by injection since failure to do so may leave the child
extremely vulnerable to stress. Each family with a child on steroids should
have an injection of hydrocortisone available and know how to give it.
Chicken pox infection may be more severe in children on steroids so, if
your child has not had chicken pox, you should inform your doctor of close
contact or the appearance of the rash. Children who require steroid treatment
for any prolonged period should have either a bracelet or necklace indicating
that they are on treatment and should carry a card with the details.
Conclusion:
Although the potential side effects of prednisolone are concerning this
is an extremely powerful and useful drug and certainly should not be avoided
when there is a clear medical indication for its use. |
