Side effects on muscles and tendons

Description: corticosteroids weaken muscles and tendons. Myopathy can affect patients in the form of muscle weakness and can become troublesome in everyday life (climbing stairs, lifting). Usually, there is no muscle pain. Cortisone can also weaken the tendons but symptoms are usually non-existent and cases of tendon rupture are rare. In addition, corticosteroids frequently cause cramps, particularly in the early stages of treatment. This side effect is not especially known to physicians but is commonplace among patients. The cramps commonly occur during the night and affect the hands and feet.

Frequency: muscle weakness usually affects patients treated for several weeks with high doses of corticosteroids. Studies have shown that 15-40% of patients treated with high doses of corticosteroids for several weeks reported muscle weakness specifically. This myopathy is usually moderate. It severely affects less than 5% of patients. The frequency of tendon damage is unknown but appears to be rare.

Subjects at risk: In general, little is known. Older patients seem most at risk. The risk of myopathy is low under 10 mg per day of prednisone or prednisolone. Moreover, some treatments taken at the same time as corticosteroids may increase the risk of tendon complications (e.g. certain antibiotics called fluoroquinolones).

Long versus short-term treatment: the risk of myopathy symptoms seems very low over short-term treatment with cortisone. This is primarily a side effect experienced after several weeks/months of treatment.

Prevention/treatment: several studies have shown that physical exercise is a great way to prevent and treat corticoid-induced muscle damage.

Screening: Screening is primarily conducted in the clinic. Laboratory tests are not useful. Certain examinations such as electromyography may be prescribed under special circumstances.

Reversibility: the myopathy is reversible after discontinuation of treatment. Muscle weakness improves, albeit slowly, and may persist for several weeks after corticosteroids have been stopped. Regular exercise can help quicken your recovery.

Useful references
  • Walsh LJ et al. Adverse effects of oral corticosteroids in relation to dose in patients with lung disease. Thorax 2001
  • Lee HJ et al. Steroid myopathy in patients with acute graft-versus-host disease treated with high-dose steroid therapy. Bone Marrow Transplant. 200
  • Fardet L et al. Corticosteroid-induced clinical adverse events: frequency, risk factors and patient's opinion. Br J Dermatol. 2007

lastest update : May 08 2015