DOUBLE-EDGED SWORD: CORTISONE
Prof.Dr. Ahmet Mesut Onat
The change in the treatment of rheumatological diseases, especially in the last 10 years, is dazzling. Especially rheumatoid arthritis, ankylosing spondylitis, systemic lupus and Behçet's disease, popularly known as 'inflammatory rheumatism', are the first of these diseases that come to mind. Diseases that primarily involve joint swelling and pain quickly limit patients' quality of life and daily living activities. The person tries to get rid of this complaint, which disturbs him a lot, as soon as possible and looks for ways to do so. First, painkillers and then cortisone treatments enter his life. Especially if the rheumatologist he consulted told him that his disease would last for many years, this drug suddenly becomes frightening for the patient.
There are many reasons why our patients who apply to us are so afraid of cortisone. However, the most effective reason is the changes in the environment on the face and body of someone who uses this medicine. And if he is told that this drug causes osteoporosis, a state of absolute depression develops.
So, should our patients really be so afraid of cortisone, or is it a normal reaction for them to resist their doctor saying that they will not take this drug in case they die? .
Unfortunately, the empty magazine mentality and false health news that has developed in our country puts us physicians in a difficult situation. The unfounded information our patients acquire from conversations with neighbors, friends and family, creates insurmountable obstacles in their minds.
Cortisone drugs, which we frequently use in rheumatic diseases, sometimes for a long time and sometimes for a short time, are as much as all other drugs currently used by humanity. They have side effects. Just as the traffic rules we follow while driving prevent us from having accidents, all treatment methods require patients to comply with certain rules.
Cortisone drugs are divided into short-medium and long-acting. The effects of other drugs, especially those used in the treatment of inflammatory rheumatic diseases, appear slowly. This period of ineffectiveness may last for a few months when complaints are intense. Cortisone treatments used in treatment relieve patients. Over time, as the effects of the main drugs used in treatment improve, cortisone doses are also reduced. The lowest dose that meets the need should always be given and a reduction should be attempted as soon as appropriate. Tablet options should be preferred for long-term treatments. The most commonly used cortisones are methylprednisolone and prednisolone. What is meant by low dose is doses below 10 mg. Lupus, vascular inflammation (vasculitis) and Behçet's diseases sometimes require very high doses of cortisone. Here, doses of 60 mg tablets or 1000 mg serum per day are used. The aim is to eliminate the danger to the patient's life. In these cases where high doses are used, the drug dose is reduced much more slowly. Otherwise, similar problems will arise again.
Long-acting cortisone injections are also methods used in the treatment of rheumatism, especially into the joint or if there are compulsory situations.
The danger is that undiagnosed patients constantly take these medications. It starts with their continued use. The patient thinks that he is relieved with cortisone, but this medicine cannot cure the disease, it only masks it. Joint damage that develops over time becomes unavoidable. The point that should not be forgotten here is the fact that these drugs can treat some diseases, while in others they are used for support purposes in addition to basic treatments. For example, while they are therapeutic in lupus disease and vasculitis, they are recommended for support in rheumatoid arthritis.
No matter how cortisone drugs are used (tablet, injection, drop or inhalation, e.g. asthma), there is an unchanging fact. In long-term cortisone use, side effects develop if there is an overdose. So why do doctors still insist on this drug? Long-term use of cortisone causes osteoporosis, cataracts, arteriosclerosis and hypertension, heart diseases, high blood sugar, increased hair growth, acne, increased appetite, and weight gain, especially on the face and body. Fat accumulation begins in different places.
While the main goal of us doctors is to protect life, a normal and healthy life, these side effects scare us on behalf of our patients. It is currently better for certain diseases and for certain purposes. Cortisone treatments are very valuable drugs until alternatives are found. While using cortisone medications, which we cannot give up, we always give advice to our patients if the treatment period will exceed 1 month. These recommendations are:
As a result, as long as the patient receives accurate information about his disease from the relevant specialist and can continue to follow up on the issues that need attention using his will, problems and side effects will be minimized. The physician will try to give the least dose of cortisone the patient needs. It is the primary duty of us doctors to strive to ensure the patient's health and avoid illness, however, informing our patients from time to time will prevent bad outcomes.
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