Everything to know about corticosteroid treatments (cortisone): use, dosage, side effects and more!

What is cortisone? What does it do? 

Belonging to the family of steroids, cortisone is produced naturally by the adrenal gland located above the kidneys. This gland, which has a pyramidal structure, is composed of two parts with different functions: the adrenal medullary gland mainly secretes adrenaline; while the adrenal cortex gland produces androgens, mineralocorticoids and glucocorticoids.

Cortisone occurs naturally in the body and is called cortisol. This hormone is essential for the regulation of our metabolism and has anti-inflammatory properties. Researchers quickly became interested in this hormone as a basis for the development of numerous medicines.

Cortisone-based medicines are used to treat a large number of diseases with an acute inflammatory reaction, such as rheumatological, ENT, dermatological, renal, bronchopulmonary and ophthalmological diseases.

Cortisone and corticosteroids are also prescribed to relieve certain chronic conditions such as multiple sclerosis or rheumatoid arthritis or as part of palliative care for certain cancers.

What are the principles of cortisone treatment?

In general, a distinction is made between corticosteroid treatments according to their duration: short-term corticosteroid treatment (less than 3 months) and long-term corticosteroid treatment (more than 3 months).

It is also necessary to define the prescribed daily dosage. When daily doses are less than 7.5 mg of prednisolone equivalent, they are considered low doses. When daily doses are between 7.5 and 30 milligrams of prednisolone equivalent, these are moderate doses. A daily dosage above 30 milligrams of prednisolone equivalent is considered high.

Adverse effects are mainly observed at high and prolonged doses.

How to start a course of corticosteroid treatment?

Some diseases require initial treatment with high doses of intravenous medication: up to 1000 milligrams per day of methylprednisolone, also known as a "bolus dose" of corticosteroids. The dose of corticoids will then be reduced when the desired therapeutic effect is achieved. This makes it possible to find the minimum effective dosage to achieve the beneficial effects of the treatment while limiting the side effects as much as possible.

When is the best time to take cortisone?

It is best to take a cortisone treatment in the morning as this is when the body naturally produces the highest doses of cortisol.
However, for conditions such as rheumatoid arthritis or autoimmune diseases, where only a very small dose of cortisone is required, treatment can be taken in the evening at bedtime to have maximum anti-inflammatory effects during sleep, where autoimmune activity is greatest.

In the case of particularly severe flare-ups, the doctor may prescribe cortisone treatment in two daily doses (in the morning and in the evening, for example to treat cervicobrachial neuralgia).

Doctors generally recommend taking the treatment with a meal.

What are the side effects of cortisone?

The side effects of cortisone are numerous: weight gain, thinning of the skin, muscle wasting or osteoporosis are some of them. Psychological side effects can also occur.

Weight gain:

Corticosteroid treatments often induce weight gain if the treatment lasts between several weeks and a few months. Weight gain is generally moderate: 1 to 2 kilos.
In addition, cortisone can change one's physical appearance. A rounding of the face (called "moon face"), a bump on the nape of the neck (called a "buffalo hump") or an increase in waist circumference may appear.
These changes are due to a redistribution of fat cells in the body ("lipodystrophy") and not to water retention.

60% of patients will show a significant change in their physical appearance after 2 or 3 months of corticoid treatment. Only 10% of patients treated over a long period of time will see a significant weight gain, or approximately a 10% increase in their initial or "usual" weight.

Side effects on the skin:

Corticosteroid treatments generally induce many skin side effects. These undesirable effects are classified into 3 types:

• Trophic (skin fragility): stretch marks, bruising, skin dryness, delayed wound healing. 
• Infectious: inflamed or infected hair follicles, for example.
• Other: acne, increased hair growth, depigmentation.

These adverse effects appear depending on the dosage and duration of treatment. They appear anywhere from 5 to 70% of patients depending on the treatment, with skin side effects often reported only after prolonged exposure to corticosteroids.

Muscle weakness:

Corticosteroid treatments weaken muscles and tendons. Muscular weakness can develop and become a hindrance in carrying out daily tasks and activities, like climbing stairs or lifting objects. However, there is little to no associated muscle pain.
Cortisone-based treatments can weaken tendons, but cases of tendon ruptures remain exceptional.
Moreover, at the outset of treatment, corticosteroids can cause cramps, often at night, mainly affecting the hands and feet.

Thinning bones (osteoporosis) and fractures:

The frequency of osteoporosis (loss of bone density) varies according to the dosage and duration of corticosteroid treatments but also according to the condition for which the treatment is required.
Osteoporosis is common in rheumatoid arthritis, for example, but very rare in asthma.
Osteoporosis can become active in the body from the first weeks of treatment, but only becomes problematic during long-term treatment.

Mood:

Corticosteroids have a minor effect on mood: insomnia, anxiety, irritability, minor memory problems and concentration difficulties in particular. In very rare cases, treatment can cause depression or delirium.

Minor mood changes are common. 40 to 50% of patients experience insomnia, anxiety or irritability. Severe disorders are rare and affect less than 5% of patients. These disorders should lead patients or their relatives to seek medical advice.

Infection:

Corticosteroids weaken the immune system. It is thanks to this ability that they can be used to treat many conditions. But this also leads to a greater risk of infection. Infections, whether bacterial, viral, parasitic or fungal, are more frequently observed in patients treated with corticosteroids. These infections can affect all organs (the digestive tract, lungs, skin, etc.). Infections can present themselves in a variety of ways, nevertheless, the onset of fever should be reported to a doctor immediately.

Are there any foods to avoid when taking cortisone?

Taking a dose of prednisolone (cortisone) of more than 15 mg per day over a long period of time exposes patients to certain adverse effects.
In order to minimise these effects, various measures can be taken from a dietary point of view:

• Eating a diet rich in protein will help limit muscle wasting. Diet should be coupled with regular physical activity.
  Adopting a diet that is low in animal fats (cream, cheese, cold meats, etc.) and high in good fats (avocado, vegetable oils, etc.). A low sugar diet is also recommended.
• Following a low-salt diet. Cortisone may cause salt retention, which can lead to high blood pressure. A diet rich in potassium may be recommended because cortisone facilitates its elimination from the body.
• Eating a calcium-rich diet with a sufficient intake of vitamin D to limit the risk of osteoporosis.

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