(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.