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Corticosteroids are often used to treat inflammatory diseases such as asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis. However, an unfortunate side effect of their use is muscle loss, or myopathy, which can cause weakness in the proximal muscles of the upper and lower limbs and the neck flexors. This condition is believed to be caused by the catabolic and anti-anabolic effects of corticosteroids, which decrease protein synthesis and increase the rate of protein catabolism, leading to muscle atrophy. While the condition is reversible, it can take weeks or even months for patients to recover their muscle strength after reducing or stopping their steroid treatment. So, what can be done to prevent muscle loss caused by corticosteroids?
| Characteristics | Values |
|---|---|
| Treatment | Taper off steroids, switch to nonfluorinated glucocorticoids, or alternate-day dosing |
| Prevention | Physical therapy, resistance and aerobic exercise, range-of-motion exercises, stretching |
| Risk Factors | Prior muscle disease, spinal cord injury, chronic respiratory illness, poor nutrition, sedentary lifestyle, female gender, older age, obesity, cancer |
| Symptoms | Muscle weakness, acute paralysis, respiratory failure, proximal limb weakness, Cushing syndrome stigmata, metabolic complications, osteoporosis |
| Complications | Joint contractures, pressure ulcers, deep vein thrombi, irreversible muscle weakness, decreased quality of life, increased risk of falls and injury |
| Mechanism | Catabolic and anti-anabolic, decreasing protein synthesis, increasing protein catabolism |
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What You'll Learn
Reduce or stop taking steroids
If you are taking steroids as medicine, do not stop taking them or reduce your dose without consulting your doctor. Steroid withdrawal symptoms can include dizziness, lightheadedness, tiredness, stomach pain, and body aches. In some cases, withdrawal can cause depression, fatigue, joint pain, anxiety, mood swings, and sleeplessness. If you are experiencing steroid withdrawal, be honest with your doctor so that you can get the right support. A doctor-assisted detox can help manage withdrawal symptoms. This may involve seeing a psychologist for cognitive behavioural therapy to address the underlying reasons for steroid use and prevent relapse.
If you are taking steroids without a prescription, you should seek medical advice as soon as possible. A doctor can advise you on how to safely reduce your dose over time to prevent a drastic shift in your hormone balance. This process is known as tapering down.
In some cases, it may be possible to switch from fluorinated to non-fluorinated glucocorticoids or to alternate-day dosing. Additionally, physical therapy in the form of resistance and aerobic exercise has been shown to prevent and treat steroid-induced myopathy.
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Switch to a different type of steroid
Anabolic steroids are medications that are manufactured forms of testosterone. They are commonly misused by athletes, bodybuilders, and others to enhance muscle growth and improve physical appearance. However, it is important to note that anabolic steroids have legitimate medical uses and are prescribed by healthcare providers for specific conditions. These conditions include male hypogonadism, certain types of breast cancer, and stimulating muscle growth for people with certain cancers or acquired immunodeficiency syndrome (AIDS).
When considering the use of anabolic steroids, it is crucial to understand the potential risks and side effects. Misuse of anabolic steroids can lead to serious health problems, including cardiovascular and liver issues. Long-term, non-medical use of anabolic-androgenic steroids (AASs) has been linked to heart problems, unwanted physical changes, and increased mortality. Additionally, continuous use of AASs can lead to tolerance, requiring higher doses to achieve the desired effects, and may even cause the body to stop producing its own testosterone.
To mitigate the potential risks associated with anabolic steroid use, it is important to consult a healthcare professional. Doctors can prescribe anabolic steroids for specific conditions and ensure their safe and effective use. Small doses of anabolic steroids, when taken for short periods and under medical supervision, carry a lower risk of harmful side effects.
If you are experiencing muscle loss or weakness due to corticosteroid use, switching to a different type of steroid should only be done under medical guidance. Anabolic steroids are not typically recommended for this purpose, as their misuse can lead to harmful side effects. It is crucial to work with a healthcare provider to determine the most appropriate treatment option for your specific situation.
In summary, while anabolic steroids can be effective in stimulating muscle growth and treating specific medical conditions, they should only be used under the supervision of a healthcare professional. Misuse of anabolic steroids can lead to serious side effects and health risks. If you are experiencing muscle loss or weakness due to corticosteroid use, consult a doctor to discuss alternative treatment options and determine the best course of action for your individual needs.
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Alter dosage
Corticosteroid-induced myopathy is a toxic noninflammatory myopathy that typically affects pelvic girdle muscles and is associated with muscle weakness and atrophy without pain. It occurs as an adverse effect of prolonged oral or intravenous glucocorticoid use, with an excess of either endogenous or exogenous corticosteroids believed to cause the condition. Endogenous corticosteroid production can arise from adrenal tumours, while exogenous corticosteroid excess can result from steroid treatment for asthma, chronic obstructive pulmonary disease, and inflammatory processes such as rheumatoid arthritis.
The side effects of steroids are highly dependent on dosage and duration. Lowering the corticosteroid dose below 30 mg/day may resolve muscle weakness. In patients who have undergone short-term, high-dose corticosteroid treatment, partial or complete recovery has been observed following steroid discontinuation. However, rapid withdrawal from steroids may cause a range of adverse symptoms, including fatigue, joint pain, muscle stiffness, and fever. Therefore, it is crucial to gradually taper the dosage to a physiologic dose to avoid these withdrawal symptoms and safely manage the condition.
Alternate-day dosing appears to reduce the risk of corticosteroid-induced myopathy. This approach can be considered in conjunction with switching to nonfluorinated synthetic glucocorticoids such as prednisone, which have a lower risk of inducing myopathy compared to fluorinated steroids like dexamethasone.
It is important to note that the mechanism behind steroid-induced myopathy is not fully understood, and there are no definitive therapy recommendations. However, addressing muscle weakness and impaired mobility through physical therapy and specific exercises is recommended. Patients should be educated about the risks and encouraged to engage in physical activities, including resistance and endurance exercises, to prevent and mitigate the effects of corticosteroid-induced myopathy.
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Resistance and aerobic exercises
Steroid myopathy is a disease process that causes weakness in the muscles of the upper and lower limbs, neck flexors, and pelvis. It is caused by an excess of either endogenous or exogenous corticosteroids. The muscles most affected are those with less activity, and the condition can be acute or chronic.
To prevent and treat steroid-induced myopathy, physical therapy in the form of resistance and aerobic exercises is recommended. This includes both endurance exercises and resistance exercises. It is important to take into account the patient's baseline functional status and build up from there. For example, bed mobility, balance activities, transfer training, and gait training can be included to address decreased mobility. Range-of-motion exercises and stretching exercises should also be performed to prevent joint contractures.
Resistance exercises should be limited to muscles with greater than antigravity strength. High-intensity exercises should be avoided as they may be harmful. Instead, exercises should be tailored to the patient's tolerance level, as exercise to tolerance may increase muscle strength.
In addition to resistance and aerobic exercises, inspiratory muscle training has been shown to prevent the impairment of respiratory muscle function in patients receiving corticosteroids.
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Physical therapy
To counteract the effects of corticosteroids on muscles, physical therapy should include both resistance and endurance exercises. It is important to note that resistance exercises should be limited to muscles with greater than antigravity strength. Bed mobility, balance activities, transfer training, and gait training can also be incorporated to address decreased mobility. However, high-intensity exercises should be avoided as they may be harmful.
In a study of heart transplant recipients on chronic glucocorticoids, a six-month regimen of monitored resistance training successfully reversed corticosteroid-induced muscle atrophy and significantly improved skeletal muscle strength. Additionally, isokinetic physical training has been found to reverse muscle atrophy and normalise strength in renal transplant patients receiving low to moderate doses of prednisone.
For patients in intensive care or with limited mobility, early physical therapy, even while undergoing life- and organ-support interventions, can be beneficial. This may include occupational therapy, which focuses on maximising the patient's ability to independently perform activities of daily living. Assistive devices, such as a balanced forearm orthosis or a raised toilet seat, may be introduced to enhance their independence.
Overall, physical therapy can be a powerful tool in the management of corticosteroid-induced myopathy, helping to prevent muscle weakness and atrophy, improving functional independence, and enhancing patients' quality of life.
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Frequently asked questions
Steroid myopathy is a disease that causes weakness in the muscles of the upper and lower limbs and the neck flexors. It is caused by an excess of either endogenous or exogenous corticosteroids.
The muscles most affected are those in the arms and legs, and the pelvis. Patients may present with several complications of chronic steroid use, including Cushing syndrome stigmata (e.g. moon facies and fat redistribution), metabolic complications, including obesity, diabetes, and adrenal insufficiency.
Reducing or stopping steroids is the most effective treatment. Physical therapy, including resistance and aerobic exercises, can also help prevent and treat steroid-induced myopathy.
Risk factors include prior muscle disease or spinal cord injury, chronic respiratory illness, poor nutritional status, and a sedentary lifestyle. Women are more prone to developing corticosteroid-induced myopathy, and old age and cancer are also risk factors.
