Why Rheumatologists will continue to use Steroid

Why Rheumatologists will continue to use Steroid

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By Dr Irwin Lim, Rheumatologist

I wrote the last two letters/posts to give you an idea of the love-hate relationship most rheumatologist have with this drug.

(read Dear Steroid, I love you... vs Dear Steroid, I hate you...)

Now for a more balanced view.

When I use the term steroid, I mean corticosteroids (Not anabolic steroids).

It is the most useful medication I have at my disposal. It gets my patients and me out of trouble. Quickly and efficiently. It is a crucial drug in some diseases and can be organ-saving and life-saving.

In some diseases, there is little other choice.

But, as rheumatologists we know of its potential side effects. Many of these are nasty and will almost certainly develop if large enough doses are used, for a prolonged period.

For a disease like rheumatoid arthritis & other inflammatory arthritis, it's why we prefer you to be on DMARD therapy. It's why we use different combinations to try and help reduce the reliance on steroid long term.

We do often still need to use the medication. But the rule of thumb is to use it at the lowest dose possible to achieve the result we need, for the shortest time possible.

It's important any reduction of steroid use be done in discussion with your rheumatologist. We don't want the disease to be destabilized and we don't want any ill effects from reducing the dose of steroid too quickly.

Please note that most of the comments above relate to oral corticosteroid. The other routes: topical, intravenous, intranasal, inhalation or injectable, have different side effect profiles.

It is regular use long term which is the biggest concern. Your rheumatologist will always try to use the lowest dose possible.

I know how patients react to steroids can be different.

Not just in how effective the drugs are or the possible side effects, but also in their cognitive response to this medication given the mixed messages they receive from friends and family trying to be helpful, the internet, and their various health professionals.

It's why a balanced discussion is needed right at the start.

What is your experience with this?

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
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