A new study on a large scale indicates an alarming link between commonly used systemic steroids and sudden rise in pain crises among sickle cell disease patients. Researchers retrospectively analyzed the records of over 5,100 patients who had been hospitalized at least once for a pain episode and examined their prescription history. The research found that those who had used systemic steroids were nearly four times more likely to be hospitalized with a vaso-occlusive crisis—a painful shutdown of an artery—a month after exposure. The median time from filling a prescription for steroids to hospitalization was just five days.
Patients who were already on hydroxyurea, a standard SCD treatment, had a decreased—but still elevated—risk, suggesting its known protective benefits. Children and males also had slightly lower risks than females and adults.
The findings support earlier warnings that despite steroids being inexpensive and powerful anti-inflammatories, their administration in SCD can do more harm than good. Randomized trials earlier suggested advantages such as faster relief and fewer hospital stays, but real outcomes have been opposed by rebound pain and increased readmissions.
There are instances of years reporting severe pain flares, stroke, and organ damage after the use of steroids in SCD patients. Steroid therapy long-term in children with other autoimmune conditions also had serious complications in over 60% of instances with high vaso-occlusive events, acute chest syndrome, strokes, and infection.
Experts now caution that systemic steroids should be avoided in most SCD cases except under the care of a specialist. Steroids used for asthma and other conditions are safe, though, because they don’t trigger such crises.
In the meantime, while the medical community investigates these reports, the news is out: for people with sickle cell disease, steroids may work to alleviate symptoms in the short term, but the cost may be too terribly high.
