The epidemiology of glucocorticoid-associated adverse events

The introduction of glucocorticoid therapy by Dr Philip Hench in the 1950s revolutionized the treatment of rheumatic and inflammatory disease. These preparations remain an important component of therapy for a variety of diseases. As with any potent medication, however, they are not without side effects. Analysis of physician understanding and practice suggest that appreciation for the frequency and significant morbidity associated with glucocorticoids is poor. The purpose of this review is to provide an update on the most recent literature regarding glucocorticoid use and associated adverse events.

Recent studies suggest that adverse events such as weight gain, skin thinning, sleep disturbance and neuropsychiatric disorders may occur in patients taking glucocorticoids. Adverse events may occur even in low-dose therapy and appear to be dose and duration dependent. Glucocorticoid-induced osteoporosis is a potentially preventable complication but physician adherence to preventive guidelines is poor. New data reinforce the understanding that glucocorticoids significantly increase the risk of infection. There are strong data-driven concerns about the increased susceptibility of children and possibly even neonates to glucocorticoid-associated adverse events.

Glucocorticoid therapy, while important in the treatment of a variety of serious inflammatory diseases, causes significant morbidity among long term users.