Myasthenia gravis steroid risks: What you need to know

Corticosteroids — or steroids — are a group of medications used to treat or relieve the symptoms of inflammatory and autoimmune disorders, such as myasthenia gravis (MG).

While steroids are highly effective medications, there are several MG steroid risks to be aware of, including mood and sleep changes, infection, and bone loss.

Understanding the risks can help you make an informed decision about taking corticosteroids for your condition.

Common steroid side effects

Corticosteroids can cause a wide range of side effects and complications, especially when taken at high doses or for a long time. Like most medications, they can cause mild or severe adverse effects.

Common side effects of steroids can include:

• upset stomach
• swelling and fluid retention
• high blood pressure
• behavior and mood changes
• weight gain and increased appetite
• abnormal hair growth
• muscle weakness
• skin changes, such as acne or unusual bruising

Steroid risks that matter specifically for MG

MG is a condition characterized by extreme fatigue and muscle weakness. This can affect your ability to do routine activities.

Although corticosteroids are effective in managing MG symptoms, they can pose specific risks for people with MG.

Worsening of MG

High doses of steroids may cause worsening of MG in 25% to 75% of people, especially in the first two weeks of starting the medication.

To reduce this risk, healthcare providers may start you on a lower dose of the steroid and slowly increase the dose over time.

Factors that can increase your risk of MG worsening include older age, generalized MG with bulbar symptoms (symptoms related to weakness in face and neck muscles, such as chewing, swallowing, and speech problems), severe MG, and MG with thymoma (a tumor on the thymus gland).

Worsening muscle weakness

MG usually causes some sort of muscle weakness or fatigue. Corticosteroids also cause muscle weakness as a side effect. Therefore, the steroid’s impact on muscle weakness may worsen your muscle-related MG symptoms.

Long-term steroid risks to be aware of

Although corticosteroids are very effective in easing symptoms of MG, there are many steroid complications associated with long-term use.

Long-term steroid effects in MG may include:

• high blood sugar, which can lead to or worsen diabetes
• increased infection risk
• steroid-related bone loss, which can lead to osteoporosis and increase the risk of bone fractures
• skin thinning and slower wound healing
• eye problems, such as cataracts or glaucoma
• a round face

How doctors reduce steroid risks

Healthcare providers use a range of strategies when managing MG steroid risks. These can include prescribing the lowest effective steroid dose.

Your provider will likely monitor you closely for steroid complications, such as infections, bone loss, high blood sugar, and high blood pressure. They may also recommend weaning off steroids once your MG symptoms significantly improve.

It’s important to take your steroid exactly as prescribed by your doctor. You should not stop taking any steroid medications on your own.

Lowering your dose or abruptly stopping the medication without the guidance or approval of a healthcare provider can lead to a life-threatening problem called adrenal crisis  — a condition that occurs when there is a sudden drop in the levels of a steroid hormone called cortisol.

When to contact your healthcare team

While steroid side effects in MG are usually mild, there are certain situations that warrant contacting your healthcare team.

Contact your doctor if you:

• develop any side effects that are severe, particularly bothersome, or worsening
• have signs or symptoms of infection, such as fever
• experience vision changes, such as blurry vision
• have symptoms of high blood sugar, such as increased thirst, urination, and hunger
• develop symptoms of high blood pressure, including headaches or dizziness
• experience extreme changes in your mood, thoughts, or behavior

Lastly, remember to contact your healthcare provider if you want to stop taking your corticosteroid. They can help determine a plan for you to taper off the medication slowly.