Steroids

Steroids aim to reduce inflammation. This medicine is used in cases of moderate to severe attacks of Crohn’s or colitis. Some examples include Prednisone and Hydrocortisone.

What are corticosteroids?

Corticosteroids inhibit the immune system. In terms of the gastrointestinal system, they inhibit the movement of inflammatory cells to the intestine. They decrease the expression of certain inflammatory chemicals called cytokines. They give rise to the death of activated white blood cells.

Corticosteroids have dramatic effects in IBD. They are a nonspecific way of reducing inflammation but they are associated with significant long-term toxicity.

Health care providers use corticosteroids sparingly due to side effects. They tend to use other medications whenever possible instead. These other drugs can help reduce the need for corticosteroids.

Examples of corticosteroids include prednisone, hydrocortisone, and budesonide. Corticosteroids are available as an oral medication or intravenously, or even as an enema. 


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How effective are corticosteroids?

Here is a summary of the effectiveness of corticosteroids for the management of IBD:

  • In general, corticosteroids are effective at inducing remission in active ulcerative colitis.

  • Corticosteroids are effective at inducing remission in active Crohn's disease.

  • ​Standard corticosteroids such as prednisone tend to be more effective than budesonide at inducing remission in active Crohn's disease.

  • The corticosteroid budesonide is NOT effective at preventing relapse in inactive Crohn's disease. 


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Side effects and risks of use

Corticosteroids are well known to have significant short-term side effects. Cosmetic side effects can include acne, redness on the face, ‘chubby cheeks’, a tendency to bruise easily, fluid retention, and weight gain.

Psychological effects include mood swings, depression, or psychosis.

Metabolic effects not already mentioned include increased appetite, increased blood pressure, and increased susceptibility to infections.

Rare side effects can include muscle weakness and osteonecrosis (reduced blood flow to the joints, especially the hip).

Long-term disorders that can develop as a result of taking corticosteroids include loss of bone mineral density, osteoporosis, and diabetes mellitus. 


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Immunizations and vaccinations

If you are taking corticosteroids, you should avoid having live vaccines from three weeks before starting this type of drug.

You should not have vaccines during the time you are on corticosteroids, up until three to six months after stopping. You should also avoid anyone who has recently had live vaccine, and avoid the nasal flu vaccine.


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