Corticosteroids are a vital tool in controlling ANCA-associated vasculitis (AAV), a condition where small blood vessels become inflamed. These medications work quickly to reduce inflammation and prevent organ damage. However, they come with a range of side effects that require careful management. Understanding these potential issues and how to address them is crucial for achieving long-term remission.
Weight Gain and Physical Changes
Weight gain, including the characteristic “moon face” (facial puffiness), is a common side effect, especially with high doses or prolonged use. Steroids increase appetite, cause water retention, and shift fat distribution to the face, neck, back, and abdomen.
While moon face is often reversible upon steroid reduction, it can take months to improve. Minimizing steroid exposure – using the lowest effective dose for the shortest duration – is the best prevention. Combining steroids with steroid-sparing medications like avacopan can also help. Lifestyle adjustments, such as limiting processed foods, sugar, and sodium, eating smaller meals, and staying active, can further mitigate weight gain.
Sleep Disturbances
Steroids don’t directly stimulate, but they can cause alertness and jitteriness, making sleep difficult. Taking steroids in the morning (for once-daily prescriptions) or before 5 p.m. (for twice-daily doses) can reduce insomnia. Maintaining good sleep hygiene – a dark, quiet environment, a consistent bedtime routine, and 7-9 hours of sleep – is also essential.
Gastrointestinal Issues
Nausea, vomiting, stomach pain, and diarrhea are common gastrointestinal side effects of steroids. In severe cases, gastritis, ulcers, or bleeding can occur. Combining steroids with NSAIDs (like ibuprofen) increases the risk fourfold. Proton pump inhibitors can protect the stomach lining when steroid-NSAID combinations are unavoidable. Taking steroids with meals can help reduce these effects.
Bone Density Loss
Long-term steroid use weakens bones, leading to osteoporosis and increased fracture risk. Up to 40% of patients on long-term steroids experience bone loss. Bone-density tests before treatment and follow-up screenings are vital. Supplementation with calcium and vitamin D, weight-bearing exercise, a healthy diet, and limiting alcohol/smoking can help preserve bone health. Bisphosphonates or other osteoporosis medications may also be considered.
Infection Risk
Steroids suppress the immune system, increasing susceptibility to infections. This risk is higher with high doses and prolonged use. Patients should report fever or respiratory symptoms immediately. Preventive measures include adequate sleep (7-9 hours), regular handwashing, a balanced diet, hydration, smoking cessation, and annual flu vaccinations.
Blood Sugar and Swelling
Corticosteroids can raise blood sugar levels by increasing glucose production and hindering insulin function. While steroids rarely cause diabetes on their own, they can worsen existing hyperglycemia. Individuals with diabetes or prediabetes should monitor blood sugar closely. Steroids also cause fluid retention, leading to swelling in the legs and abdomen. Limiting salt intake and regular exercise can help manage this.
Eye Conditions
Steroid use increases the risk of cataracts and glaucoma. Regular eye exams are crucial, especially with long-term treatment. Blurred vision at the start of treatment is usually benign, but new vision changes should be reported immediately.
Working With Your Care Team
Effective management requires open communication with your healthcare team. Discuss side effects promptly to adjust treatment and minimize harm. Never stop steroids abruptly, as this can trigger an adrenal crisis, a life-threatening condition. A gradual taper under medical supervision is essential, especially after more than three months of use.
Medications like avacopan can help facilitate tapering. For severe cases, rituximab or cyclophosphamide may be combined with steroids to achieve remission.
Ultimately, corticosteroids remain a powerful tool for managing AAV, but their side effects must be proactively addressed. Lifestyle changes, dosage adjustments, and close medical supervision are critical for minimizing harm and maximizing treatment success.
Editorial Sources
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Resources
- ANCA-Associated Vasculitis. Cleveland Clinic. October 15, 2025.
- Fardet L et al. Long-Term Systemic Glucocorticoid Therapy and Weight Gain: A Population-Based Cohort Study. Rheumatology. March 2021.
- Jayne DRW et al. Avacopan for the Treatment of ANCA-Associated Vasculitis. The New England Journal of Medicine. February 17, 2021.
- Prednisone Withdrawal: Why Taper Down Slowly? Mayo Clinic. July 2, 2024.
