Q: I am a 16 years old boy suffering from a condition in which I have high fever all the time. The exact cause of the fever is unknown hence I have to take steroids (wysolone) as prescribed by a reputed doctor. Earlier, I didn't know the harmful effects of steroids but having known them now, I ask for your suggestions. I took 50 mg of steroids thrice in a week for 8 months. This has reduced to 2.5 mg thrice a week since a month. I am already suffering from side effects like bone ache, sleep problems, exhaustion, body ache, etc.

A:Steroids (glucocorticoids) are used to treat a myriad of disorders due their role in body homeostasis, metabolic processes and regulation of immune response. Long-term therapy, injudicious use and non-physiological withdrawal of glucocorticoids are associated with significant adverse effects. However their use is justified for known indications, but should be monitored by a specialist. Knowledge of steroid physiology and pharmacology helps to optimise therapy with glucocorticoids. Important long-term adverse effects include growth retardation in young children, osteoporosis (brittle bones), avascular necrosis of head of femur (degeneration and death of the bone due poor blood supply), immunosuppression (suppression of immunity), hypertension and suppression of the brain-pituitary-adrenal axis, which controls steroid secretion in the body. Insulin resistance (diabetes), benign intracranial hypertension (headaches due to increased pressure in the brain), cataract, muscle weakness (myopathy), obesity and psychosis are other common adverse effects of steroid therapy. As you can see, some of your symptoms could be due to steroid treatment, but a final opinion is possible after review of the primary disease by a specialist. The following advice is generally given when long-term use of steroids is necessary. Use glucocorticoids only if necessary. Use the form of steroid with lowest potency. Use the lowest effective dose of steroid. Taper the steroid dose as soon as possible. Switch to alternate day regimen instead of daily use. Use steroid sparing agents if long-term treatment is essential. Avoid stress dosing (hiking of dose) of steroids during minor infections. Physical activity is encouraged to ensure normal muscular function and prevent weight gain. Supplementation of calcium and vitamin D are given to all children on very high dose steroid treatment for more than four weeks.