Dominic Stone
Oral steroids, such as prednisone, are known to cause muscle pain and weakness. Corticosteroids, in particular, are believed to cause myopathy, which is characterised by muscle weakness and atrophy. This condition typically develops with doses higher than 10 mg prednisone equivalents per day for four weeks or longer. Muscle pain and weakness can also be caused by other medications, including antibiotics, acne medications, and statins. Corticosteroid-induced myopathy is usually reversible, with improvement occurring within 3 to 4 weeks of tapering steroids, although recovery can take several months.
| Characteristics | Values |
|---|---|
| Do steroids cause muscle pain? | Oral steroids such as prednisone can cause muscle and joint pain. Corticosteroids, however, rarely cause muscle pain but can lead to muscle weakness and atrophy. |
| Conditions that steroids cause muscle pain | Fluoroquinolone antibiotics, statins, fibrates, aromatase inhibitors, acne medications |
| Treatment for muscle pain caused by steroids | Applying hot or cold compresses, massage therapy, over-the-counter pain relievers such as ibuprofen, physical therapy, resistance and aerobic exercises, reducing steroid dosage or discontinuing steroids |
| Risk factors for steroid-induced myopathy | Higher doses (e.g., >10 mg prednisone equivalents/day for four weeks or longer), older age, male gender, obesity, female gender |
| Complications of steroid-induced myopathy | Morbidity, mortality, decreased quality of life, increased risk of falls and injuries, chronic and irreversible changes, osteoporosis, joint contractures, pressure ulcers, deep vein thrombi |
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What You'll Learn
Oral steroids like prednisone can cause muscle pain
Oral steroids are a broad group of medications that relieve swelling, pain, and inflammation. However, they can also have several side effects, some of which are short-term, while others are associated with long-term use. Prednisone is one such oral steroid that can cause muscle pain and weakness, joint pain, and other musculoskeletal issues. This condition is known as steroid-induced myopathy, which specifically affects the pelvic muscles and presents as muscle weakness without pain. It is important to note that older individuals and women are more susceptible to developing steroid-induced myopathy, but it can occur in anyone taking steroids for extended periods, especially at higher doses.
The risk of developing myopathy is typically low when the daily prednisone dosage is below 10 mg. However, when higher doses of prednisone or other oral steroids are administered for several weeks or months, the likelihood of muscle weakness increases. This muscle weakness can significantly impact daily activities such as climbing stairs or lifting objects. While muscle pain is not a typical symptom of corticosteroid-induced myopathy, it is listed as a potential side effect of prednisone by the NHS.
The diagnosis of corticosteroid-induced myopathy requires a high index of suspicion and is confirmed when muscle weakness improves within 3 to 4 weeks of tapering or discontinuing steroids. Recovery may take several months to a year, and physical therapy, including aerobic and resistance exercises, can aid in modulating muscle atrophy and improving skeletal muscle strength. Switching from fluorinated glucocorticoids like dexamethasone to nonfluorinated glucocorticoids like prednisone can also be a treatment option.
It is important to be cautious when considering discontinuing or reducing the dosage of oral steroids like prednisone, as sudden changes can lead to adverse effects. Instead, it is recommended to consult a healthcare professional to determine the best course of action. They may suggest alternative treatments or recommend non-medication options such as applying hot or cold compresses or trying massage therapy to alleviate muscle pain and soreness. Over-the-counter pain relievers, such as ibuprofen, may also be suggested to manage pain symptoms.
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Corticosteroids cause muscle weakness
Corticosteroids are believed to cause muscle weakness, or myopathy, due to an excess of either endogenous or exogenous corticosteroids. Endogenous corticosteroid production can be caused by adrenal tumours, while exogenous corticosteroid excess can be a result of steroid treatments for asthma, chronic obstructive pulmonary disease, and inflammatory processes like polymyositis, connective tissue disorders, and rheumatoid arthritis. Corticosteroid-induced myopathy is a toxic noninflammatory myopathy that typically affects pelvic girdle muscles and is associated with muscle weakness and atrophy without pain.
The prevalence of corticosteroid-induced myopathy is higher in patients with autoimmune blistering disease (AIBD) treated with glucocorticoids, with muscle weakness developing in 47.5% of patients in one study. The risk of developing myopathy is also higher in older individuals, males, and those with obesity. In addition, women appear to be twice as likely as men to develop muscle weakness from corticosteroids, although the reason is unclear.
The diagnosis of corticosteroid-induced myopathy requires a high level of suspicion and is confirmed when muscle weakness improves after 3 to 4 weeks of tapering steroids. However, full recovery can take months to a year. Treatment options include steroid withdrawal, switching to nonfluorinated glucocorticoids, or alternate-day dosing. Physical therapy, including resistance and aerobic exercises, has been shown to be effective in preventing and treating corticosteroid-induced myopathy.
It is important to note that corticosteroid-induced myopathy is almost always reversible, and patients may experience improvement within 3 to 4 weeks of tapering corticosteroids. However, recovery can vary, and some patients may experience chronic and irreversible changes if steroids are continued. To prevent these complications, the corticosteroid dose should be reduced or discontinued when possible.
To summarise, corticosteroids can cause muscle weakness through a variety of mechanisms, leading to a condition known as corticosteroid-induced myopathy. The risk of developing this condition is higher in certain populations, and treatment options include steroid withdrawal and physical therapy. While the condition is usually reversible, it is important to carefully manage corticosteroid doses to avoid potential chronic and irreversible changes.
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Corticosteroid-induced myopathy is reversible
Corticosteroids are often administered to treat asthma, chronic obstructive pulmonary disease, and inflammatory processes such as polymyositis, connective tissue disorders, and rheumatoid arthritis. They can also be used to treat acute graft-versus-host disease. Corticosteroid-induced myopathy is a toxic non-inflammatory myopathy caused by exogenous corticosteroid administration. It is a common condition that affects the pelvic girdle muscles and is associated with muscle weakness and atrophy without pain. The exact incidence of steroid myopathy is unknown, but it is believed to be caused by an excess of either endogenous or exogenous corticosteroids. Endogenous corticosteroid excess can arise from adrenal tumours, while exogenous corticosteroid excess can result from steroid treatment.
Corticosteroid-induced myopathy is almost always reversible. Recovery typically begins within 3 to 4 weeks of tapering or discontinuing corticosteroids, but it may take months to a year for full recovery. In addition to steroid withdrawal, supportive management with an emphasis on physical therapy should be considered for both prevention and treatment. Physical therapy with aerobic and resistance exercises is effective at modulating muscle atrophy in patients with corticosteroid-induced myopathy. Studies have shown that even for patients unable to taper off steroids, a 6-month regimen of monitored resistance training successfully reversed corticosteroid-induced muscle atrophy and improved skeletal muscle strength by 400-600%.
Patients should be informed that physical activity can help prevent and mitigate the effects of corticosteroid-induced myopathy, and they should be prescribed physical therapy as part of a preventive and treatment regimen. Regular exercise can help quicken recovery. A program of screening for steroid-induced myopathy should be implemented in the appropriate patient population.
Other options besides steroid withdrawal include switching from fluorinated to non-fluorinated glucocorticoids or alternate-day dosing. It is important to recognise that patients on chronic steroid therapy need to be weaned off slowly to avoid adrenal insufficiency or exacerbation of the disease being treated with steroids.
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Muscle pain can be treated with hot/cold compresses and OTC pain relievers
While steroids can cause muscle pain and weakness, this side effect is usually mild and short-term. If you are experiencing muscle pain, it is recommended that you consult your healthcare provider to determine the best course of action. In the meantime, you can treat muscle pain at home with hot/cold compresses and over-the-counter (OTC) pain relievers.
Hot and cold compresses can be applied to the affected area to help reduce inflammation and pain. Alternating between hot and cold can be especially effective in reducing muscle pain and improving recovery. For heat therapy, you can use a hot water bottle, heating pad, or a warm bath. For cold therapy, ice packs or cold gel packs can be applied to the sore area. It is important to wrap the hot or cold compress in a towel or cloth to avoid direct contact with the skin and prevent skin damage.
Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin), can also help alleviate muscle pain. These medications can reduce inflammation and provide temporary relief from pain. It is important to follow the instructions on the package or consult your pharmacist for guidance on dosage and frequency.
In addition to hot/cold compresses and OTC pain relievers, light exercise and stretching can aid in muscle pain relief. Gentle movements can help improve blood flow to the affected area, reduce stiffness, and promote healing. However, it is important to avoid strenuous activity or high-intensity exercise that may further strain the muscles.
While these treatments can provide relief, it is important to address the underlying cause of the muscle pain. If steroid use is deemed to be the cause, your healthcare provider may recommend adjusting the dosage or tapering off the medication under medical supervision. It is important to not stop taking any prescribed medication without first consulting your doctor.
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Corticosteroids cause muscle atrophy
Corticosteroids are believed to cause muscle atrophy through both catabolic and anti-anabolic mechanisms. Glucocorticoids have a direct catabolic effect on muscle, decreasing protein synthesis and increasing the rate of protein catabolism, leading to muscle atrophy. Corticosteroids with high mineralocorticoid activity also lower serum potassium and phosphate levels, which may contribute to muscle weakness.
Corticosteroid-induced myopathy is a toxic noninflammatory myopathy caused by exogenous corticosteroid administration. It typically develops with doses higher than 10 mg prednisone equivalents per day used for four weeks or longer. The condition usually affects the pelvic girdle muscles, resulting in muscle weakness and atrophy without associated pain. Proximal muscle weakness is more pronounced than distal muscle weakness, and severe relative weakness of the anterior tibialis muscle can also occur.
Corticosteroid-induced myopathy can be diagnosed through a physical exam, which may reveal objective signs of muscle weakness and decreased muscle stretch reflexes in the affected extremities. EMG studies and muscle biopsies can also aid in diagnosis, with biopsies showing atrophy of type 2b fast-twitch muscle fibers. It is important to note that corticosteroid-induced myopathy is almost always reversible, with improvement typically occurring within 3 to 4 weeks of tapering corticosteroids, although full recovery may take months to a year.
Physical therapy, including aerobic and resistance exercises, is an effective treatment for corticosteroid-induced myopathy. Even for patients unable to taper off steroids, studies have shown that a monitored resistance training regimen can successfully reverse corticosteroid-induced muscle atrophy and improve skeletal muscle strength. Additionally, range-of-motion exercises, stretching exercises, and occupational therapy can help prevent joint contractures and improve a patient's ability to perform activities of daily living.
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Frequently asked questions
Oral steroids such as prednisone can cause muscle pain and weakness. However, corticosteroids typically cause muscle weakness and atrophy, rather than pain. Corticosteroid-induced myopathy is almost always reversible, with improvement in myopathy within 3 to 4 weeks of tapering corticosteroids, although recovery can take months to a year.
If you are experiencing muscle pain, your doctor may recommend over-the-counter (OTC) pain relievers such as ibuprofen (Advil, Motrin). They may also suggest applying a hot or cold compress or getting massage therapy.
The side effects of steroids include muscle weakness, weight gain, "moon face" (a puffy, rounded face), very bad headaches, slow wound healing, muscle cramps, and changes in heart rate.
