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The risks are related to the dose accumulated in the body and the nature of the product used. In addition, depending on the individual, there is a greater or lesser tolerance. Some people will tolerate high doses well, while others will have side effects, even at low doses. There are ways to prevent, or at least decrease, the intensity of these inconveniences, called side effects or adverse effects. The main side effects are the following :
Swelling of the face, weight gain, especially at the beginning of treatment and for high doses: it is recommended to avoid adding salt, to limit sugars (both fast and slow sugars that are present in starchy foods: pasta, bread, rice, potato, semolina ...), not to eat between meals and not to increase your food ration. If this happens, which is far from constant with good food hygiene, it gradually disappears when cortisone doses decrease.
High blood pressure: it is recommended to regularly check your blood pressure, especially in case of kidney damage
Increased risk of infection: it is recommended to be up to date in your vaccination records and avoid contact with sick subjects during acute periods of infection.
In patients from tropical areas or who have spent a long time in these regions, starting cortisone treatment can "wake up" parasites present in the body, such as, for example, anguillulosis. This problem can be prevented by taking an antiparasitic treatment before starting cortisone treatment.
Risk of diabetes: regular control of blood sugar levels, especially at the beginning of treatment.
Long-term risk of bone fragility (osteoporosis): It is recommended to regularly take calcium, vitamin D and sometimes drugs that promote bone reconstruction, such as bisphosphonates (especially after menopause), as well as to exercise regularly.
Vascular cutaneous fragility with the possibility of the occurrence of "bruises" during shocks and stretch marks.
Avascular osteonecrosis, i.e. the reduction of blood circulation in long bones, which can be due to lupus itself, to antiphospholipid antobodies and/or corticosteroids
Atrophy of certain muscles: it is recommended to do regular strength training and sports.
Increased cardio-vascular risk and atherosclerosis particularly for high / moderate corticosteroid dose (higher than 5-7.5mg/kg)
Risk of cataracts: risk of cataracts and glaucoma (increased tension in the eye): it is recommended to have an ophthalmological check up every year, including the measurement of intraocular pressure. These risks are higher when cortisone is given for a very long time.
Contrary to popular belief, corticosteroids do not have a harmful effect on the stomach (unlike non-steroidal anti-inflammatory drugs and aspirin in high doses). However, a gastric protector can be added when corticosteroids are taken in combination with a small dose of aspirin. At the cholic level, corticosteroids can promote superinfection of diverticular sigmoiditis. Finally, it should be noted that abruptly interrupting corticosteroid treatment carries a risk of adrenal insufficiency, especially if this treatment has been taken for a long time.
You should never stop your cortisone abruptly. If you want to modify your treatment, ask your doctor so that he or she can decide with you on a possible modification of the treatment. This is also appropriate in case of a particularly stressful effect.
> There are simple measures to avoid or limit the long-term inconveniences of cortisone
> One of the essential objectives, when taking cortisone long-term, is to reach the minimum effective dose as soon as possible.