Steroids, also known as corticosteroids, are a type of drug often used to reduce symptoms in people with myasthenia gravis (MG). Steroids are usually taken along with acetylcholinesterase inhibitors. Most people with MG take steroids or other immunosuppressants at some point in their lives.1
One small study from 2013 also found that people with MG who take high doses of the steroid prednisone just before, during, and just after thymectomy surgery have fewer serious complications after surgery and better long-term results.2
What are glucocorticoids?
Glucocorticoid drugs (also known as corticosteroids, cortisone, or steroids) are man-made versions of the glucocorticoid hormones that your body naturally produces. These are the hormones your body produces in response to stress, especially cortisol. These hormones act as chemical messengers to regulate several body functions, including blood pressure and the immune system.
Steroids are also used to relieve symptoms of other autoimmune diseases such as rheumatoid arthritis, lupus, and multiple sclerosis.
How do steroids work?
Steroids reduce inflammation by suppressing the immune system. This means that the body's immune system produces less harmful antibodies and is like likely to attack healthy tissue. However, this also makes the body less able to fight infections. In people with myasthenia gravis, steroids are used when acetylcholinesterase inhibitors do not fully control symptoms.1
Many people with generalized MG need to take both an acetylcholinesterase inhibitor and a non-steroidal immunosuppressant long-term. Steroids are usually used for short-term relief to quickly reduce symptoms. Doctors try to avoid giving high doses of steroids over long periods due to their many side effects.1
Examples
Prednisone is the most commonly prescribed steroid to fight the inflammation caused by myasthenia gravis because of its low cost and relative safety. Prednisone is sold under many different brand names, including predniSONE Intensol, Rayos, and Deltasone®, to name a few.
Prednisolone and methylprednisolone are similar drugs prescribed if someone cannot take prednisone, such as those with liver disease.
What are the possible side effects?
Side effects can vary depending on the specific drug you are taking. The pros and cons of taking steroids regularly for years are not fully understood. While long-term use of high-dose steroids clearly leads to several side effects, some studies show little damage with the long-term use of low doses of steroids. Other studies show long-term use of any amount, even low doses, may be harmful and cause serious side effects.
The benefits of taking steroids, however, must be weighed with the many potential side effects known to result from long-term use, especially long-term use at high doses.
Some side effects of taking steroids, especially high doses, for years include:3
- Anxiety and irritability
- Avascular necrosis (bone tissue death) in the hips and knees
- Cataracts or glaucoma
- Cushing’s syndrome (redistribution of body fat)
- Depression
- Fast, irregular heartbeat
- Fluid retention
- Raised blood pressure, blood sugar, cholesterol, or triglyceride levels
- Osteoporosis
- Problems concentrating or remembering, confusion
- Shortness of breath
- Skin thinning and easy bruising
- Stomach upset and ulcers
- Trouble sleeping
- Trouble fighting off infections
- Weight gain due to increased appetite
These are not all the possible side effects of steroids. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with steroids.
Steroid-induced flares
Steroids sometimes create what is called an exacerbation, or flare, of MG symptoms. This side effect is most common in older patients, those with weakness in mouth and throat muscles, and people with severe MG. It usually happens when the person first begins taking steroids.4
Other things to know
Your doctor may suggest you take calcium (1,500 mg/day) and vitamin D (400 to 800 IU/day) to reduce the chances of osteoporosis. People with MG who also have a history of ulcers or stomach upset may need to take medication to protect the stomach.1
Steroids should not be taken at night to prevent insomnia (trouble sleeping). Blood pressure and blood sugar levels should be checked regularly. While taking steroids and other immunosuppressants it is important to avoid crowds and people with contagious diseases and wash your hands often.1,6
Before beginning treatment for myasthenia gravis, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.
