How steroids affect your immune system
If you’ve been prescribed a steroid medication such as prednisone or prednisolone, it’s important to know that you may be at an increased risk of getting an infection. The risks of infection are closely linked to your dose and the length of time you’ve been taking steroids, with higher doses and longer courses associated with increased risk. However, even low-dose steroids are known to be associated with increased risks of certain kinds of infections, some of which can be serious. So, if you’re being treated with steroids, it’s worth knowing what to look out for and how you can protect yourself.
The first thing to understand is that steroid-related infections can occur in many parts of the body. This includes the skin, soft tissue, urinary tract and lungs. In the lungs, pneumonia is a particular risk. You may also develop what’s known as an “opportunistic infection” - an infection caused by an organism that doesn’t usually cause a problem in a patient with a healthy immune system.
Why does this happen?
While steroids have saved countless lives and improved many more, their action reduces the body's ability to fight off infections. That’s because steroids reduce the strength of the immune response. They are often prescribed for autoimmune diseases (like arthritis, vasculitis, lupus, and inflammatory bowel disease) or other inflammatory conditions such as asthma, in which the immune system triggers counterproductive levels of inflammation.
What to look out for
When you take steroids, it’s important to bear in mind that the early warning signs of an infection can be hard to spot because your body’s natural (inflammatory) response to infection can be dulled by your steroid treatment.
Keep an eye out for anything unusual, including the classic signs of infections such as fevers, aching muscles, headaches, and feeling cold, shivery, or generally unwell. Being mindful of and tracking your concerns - even when they may be mild - is important so that you and your doctor can work together to manage your treatment. When it comes to suspected infections, early consultation with your doctor is crucial as it can help stop a small infection from becoming more serious.
“With steroids, the early warning signs of an infection can be harder to spot”
Top tips for preventing infections
Dr Camille Kotton, an Infectious Disease specialist from Harvard Medical School and the Massachusetts General Hospital, believes in the benefits of steroids when used as prescribed. She also acknowledges the importance of sound management of infection risk with preventative measures when appropriate and early intervention on the treatment of infections as necessary.
Here are Dr Kotton’s six top tips for reducing the risk of infection while taking high doses of steroids:
- Make sure you stay up-to-date with all of your recommended vaccinations.
- Follow your doctor's advice on taking preventative antibiotics, especially if you're taking higher steroid doses or being treated for the long term.
- Don't hesitate to reach out to your doctor if you suspect an infection. It’s much easier to treat infections if treatment begins early.
- Think about making small changes to your day-to-day life to strengthen your defenses. This could include wearing gloves and other protective clothing to prevent cuts or injuries that could lead to infections.
- If you love gardening or work outdoors, you might consider wearing a face mask to reduce the risk of inhaling mold spores or other infectious agents.
- If you’re planning a trip abroad, speak with your clinician or travel clinic to ensure you’re fully vaccinated for each of the places you’ll visit.
Dr Kotton says: “There are lots of ways [to avoid infections]. Prevention is the best way to stay healthy. Vaccines and antibiotics can help keep nasty infections at bay.”
To hear more from Dr Kotton, watch our film on infections.
The bottom line
Steroids are incredibly effective for managing many inflammatory and autoimmune conditions. However, their impact on the immune system can be significant, leaving you more prone to picking up infections. By taking steps to protect yourself, such as keeping up to date with vaccines and discussing any concerns with your doctor, you’re giving yourself the best chance of staying healthy.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.