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How do you avoid and treat steroid side effects?

Three broad groups of steroid-related side effects can be identified, although 50% of patients with inflammatory bowel disease (IBD) report no adverse event on prednisolone. Early effects caused by supraphysiologic doses include cosmetic, sleep and mood disturbance, dyspepsia, and glucose intolerance. Effects from prolonged use (usually 12 weeks, but sometimes less) include posterior subcapsular cataracts, hypertension, hyperlipidemia, osteoporosis, osteonecrosis, myopathy, and susceptibility to infection. Effects during withdrawal include acute adrenal insufficiency (from sudden cessation), a syndrome of pseudorheumatism (with myalgia, malaise, and arthralgia, similar to a recrudescence of Crohn’s disease [CD]), or raised intracranial pressure. The options to avoid these are to use steroid-sparing agents, employ steroids with low systemic bioavailability, or to try and avoid steroids altogether by approaches that include surgery.