What Makes Corticosteroids so Beneficial? | Johns Hopkins

By Adem Lewis / in , , , , , , /

(peaceful music) – So, your doctor has prescribed a medication for you that is a steroid. This medication may go by
the name of prednisone, methylprednisolone, or hydrocortisone. Prednisone is a corticosteroid,
or a glucocorticoid. These medications are commonly
referred to as steroids, but it’s important to
clarify that these are a very different type of
steroid than you may hear about in the world of sports as
performance-enhancing drugs. Corticosteroids or prednisone will not make you stronger or faster. Rather, the goal of these medications is to treat inflammation. Your body actually naturally
makes all sorts of steroids. Specifically, your adrenal gland, which sits on top of the kidney, produces a glucocorticoid called cortisol. Prednisone is a synthetic, or man-made, medication that mimics the effects of your naturally produced cortisol, but with prednisone, we can increase the anti-inflammatory effects of this glucocorticoid
by using higher doses than what is made naturally by your body. Prednisone works to decrease
inflammation in several ways. It binds to
glucocorticoid-specific receptors, which are found on almost
every cell in your body. Once the medication binds to the receptor, the cell then sends signals
to decrease the production of proteins and other cells which promote or increase inflammation and
activate the immune system. Prednisone also activates and inhibits certain genes in cells
to increase production of anti-inflammatory pathways. All of this results in prednisone acting as a very strong
anti-inflammatory medication. Corticosteroids can be
prescribed and administered in several different
ways: oral, intravenous, topical, inhaled, or by injection. Oral steroids are given
as pills or tablets. Common names include prednisone, methylprednisolone, or hydrocortisone. Prednisone and
methylprednisolone can be given as once-daily medications or
split into twice-a-day dosing. Some people have difficulty
sleeping with this medication, and so, once-a-day dosing in the morning is preferred for these patients. Hydrocortisone is closer to your body’s own natural cortisol. It mimics your body’s normal
circadian rhythm of cortisol, so, twice-a-day dosing is recommended. Delayed or modified-release prednisone has a time-release coding. This medication is designed
to be taken at bedtime with a slow, reliable
release overnight and peaks in the morning, which is when
many inflammatory symptoms, such as those seen in rheumatoid arthritis and polymyalgia rheumatica,
are at their worst. Intravenous, or IV, steroids
can be given by a doctor or a nurse when a patient
cannot take oral medications or if very high doses of
steroids are required. This is common during or after surgery. IV steroids include methylprednisolone, hydrocortisone, and dexamethasone. Topical steroids can be
given as a gel or a cream. These are commonly prescribed for inflammatory skin conditions, such as eczema, psoriasis, or poison ivy. Inhaled steroids are used
to treat asthma or COPD. Examples of these medications include fluticasone, beclomethasone,
and budesonide. Injectable steroids are given by a needle. They’re often used to treat arthritis, particularly osteoarthritis, or joint and tendon
inflammation, such as bursitis. The medication is delivered by a needle directly to the target joint, or tendon, or tissue by an experienced physician, nurse practitioner, or
physician assistant. There are hundreds of conditions where treatment with
corticosteroids is appropriate, but I will briefly list some
of the most common conditions in the categories of lung
conditions, allergic reactions, and autoimmune or rheumatologic diseases. Steroids have been used to
treat asthma since the 1950s. This is one of the most common
lung conditions in the world. Both inhaled and oral
corticosteroids can be very beneficial to relieve
acute asthma attacks. They also can be used to
prevent recurrence of attacks. An allergy is when a
person’s immune system reacts to a food, medication, or
something found in nature, such as dust, pollen, bee
venom, or other insect bites. Most allergies are mild, but severe allergies can
be extremely dangerous and cause life-threatening complications, such as swelling of the airway. Corticosteroids, both
oral and intravenous, help to stop the immune reaction which occurs during an allergic reaction. Steroids are very important in the treatment of these processes. Corticosteroids have a role in the treatment of many
autoimmune diseases. In autoimmune disease, the immune system, which is supposed to protect
you from viruses and bacteria, becomes confused, and it
starts to attack parts of you. The target tissue in autoimmune disease can really be anything in your body. It can be the joints, such
as in rheumatoid arthritis, the blood vessels, such as in vasculitis, the gastrointestinal tract, such as in Crohn’s disease
and ulcerative colitis, the nerves, which we see
in multiple sclerosis, the lungs, the skin, the eyes. Just about anywhere can be involved. Prednisone or corticosteroids are often the first-line treatment for
these autoimmune diseases because steroids work fast and effectively to turn off inflammation. Many of these autoimmune
diseases also require treatment with other immunosuppressing medications in the long term to keep the immune system from being so extremely overactive, and to limit the
long-term use of steroids.

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