From the Guidelines
Long-term use of oral steroids for autoimmune disease treatment commonly causes several significant side effects, including weight gain, increased risk of infections, osteoporosis, high blood pressure, elevated blood sugar, cataracts, glaucoma, and skin thinning with easy bruising, as reported in a 2019 study 1. These side effects can be managed with careful monitoring and adjustments to treatment, such as tapering the steroid dose or adding supplements like calcium and vitamin D to mitigate bone loss. Some key side effects to watch for include:
- Weight gain with fat redistribution (moon face, buffalo hump)
- Increased risk of infections
- Osteoporosis
- High blood pressure
- Elevated blood sugar (potentially leading to diabetes)
- Cataracts
- Glaucoma
- Skin thinning with easy bruising
- Mood changes, including irritability, anxiety, or depression
- Muscle weakness, particularly in the legs and arms
- Decreased wound healing
- Adrenal suppression, which can make sudden steroid discontinuation dangerous
- Gastrointestinal issues like ulcers, especially when steroids are combined with NSAIDs. According to a 2020 study 1, the management of these side effects is crucial to improve the quality of life of patients with autoimmune diseases. A 2019 study 1 also highlights the importance of monitoring patients for potential corticosteroid side effects, including hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation or ulcer formation, glaucoma, myopathy, and osteoporosis. Overall, the risk of these side effects increases with higher doses and longer treatment duration, so doctors typically use the lowest effective dose and may prescribe supplements like calcium and vitamin D to mitigate bone loss, as recommended in a 2014 study 1.
From the FDA Drug Label
ADVERSE REACTIONS (listed alphabetically, under each subsection) The following adverse reactions have been reported with prednisone or other corticosteroids:
- Allergic Reactions
- Cardiovascular System
- Dermatologic
- Endocrine
- Fluid and Electrolyte Disturbances
- Gastrointestinal
- Hematologic
- Metabolic
- Musculoskeletal
- Neurologic
- Ophthalmic
- Other
The most common side effects for a person with long-term use of oral steroids for treatment of autoimmune disease include:
- Osteoporosis
- Glaucoma
- Cushingoid state
- Diabetes mellitus
- Hypertension
- Peptic ulcer
- Psychiatric derangements
- Suppression of growth in pediatric patients
- Adrenal insufficiency
- Immunosuppression
- Increased risk of infection
- Moon face
- Weight gain
- Acne
- Hirsutism
- Thinning skin
- Easy bruising 2
From the Research
Common Side Effects of Long-Term Oral Steroid Use
The use of oral steroids for the treatment of autoimmune diseases can lead to several side effects, particularly with long-term use. Some of the common side effects include:
- Infections 3
- Diabetes 3
- Osteoporosis 3
- Psychiatric disorders 3
- Glucose intolerance 4
- Pancreatic enlargement 4
- Bile duct stenosis 4
Organ-Specific Side Effects
Long-term oral steroid use can also affect various organ systems, leading to:
- Increased risk of osteoporosis and fractures due to bone loss 3
- Development of cataracts and glaucoma in the eyes
- Increased risk of infections, particularly in the lungs and urinary tract 3
- Mood changes, anxiety, and depression due to psychiatric effects 3
Disease-Specific Considerations
The side effects of long-term oral steroid use can vary depending on the underlying autoimmune disease being treated. For example:
- In autoimmune pancreatitis, long-term steroid use can lead to pancreatic enlargement and bile duct stenosis 4
- In severe asthma, long-term oral steroid use can increase the risk of infections, diabetes, and osteoporosis 3
- In autoimmune inner ear disease, methotrexate has been studied as an alternative to long-term steroid use, but its effectiveness is still unclear 5
Management of Side Effects
To minimize the risk of side effects, it is essential to: