Glucocorticoids

Glucocorticoids are a group of steroid compounds that are both naturally occurring and synthetically manufactured. They act as an anti-inflammatory and as agents that suppress the immune system. Also known as corticosteroids, these agents generally act to suppress the body's ability to cause inflammation both upon the surface of the skin as well as in that occurring in muscles and joints.

The process by which glucocorticoids are released within the body begins in the adrenal cortex of the brain. It is there that special hormones (providing chemical signals to the body) are released to trigger the production of one of three materials: peptides, proteins, or steroids. Steroids are a multiple-ringed molecule, closely related to the fats ingested by the body; vitamin D, cholesterol, and the female hormone estrogen are all steroids. The steroids produced through this process within the body are not to be confused with anabolic steroids, artificially manufactured drugs used in the building of muscle mass.

The signal from the adrenal cortex that ultimately results in the release of a cortisol steroid is intended to provide anti-inflammatory relief to the portion of the body that needs it. Cortisone is delivered through the bloodstream to the affected area, and it will continue to be produced by the body for so long as inflammation is signaled to the adrenal cortex.

Glucocorticoids have been synthesized for use as anti-inflammatory medications for many years. The best known of the synthetics are prednisone and cortisone; each has a similar function. Prednisone is very similar in its chemical composition to that of cortisone, but often has a more pronounced and immediate effect than cortisone. Prednisone is commonly prescribed to combat inflammation associated with arthritis, bursitis as it may occur in any joint of the body that is constructed with a cushioning fluid sac known as the bursa, and synovitis, the inflammation of the fluid structures surrounding joints such as the ankle. Prednisone is administered in a tablet form. The usage of prednisone may lead to pronounced side effects, including mood changes, increased appetite, a heightened risk of infection due to the negative impact on the immune system, and fluid retention. In the longer term, prednisone can contribute to osteoporosis, as it may interfere in the proper conversion of calcium to bone formation.

Cortisone has a long history of specific sports injury applications. Injuries that are caused by overuse or repetitive strain have commonly been targeted for cortisone therapy. The cortisone used is a synthetic version, and is typically administered by way of injection directly into the affected area. The cortisone provided in an injection, due to the concentrated amount delivered in contrast to that manufactured naturally in the body, is intended to have a pronounced and immediate anti-inflammatory effect. Cortisone does not possess any analgesic, or pain-killing, properties. Cortisone is often administered to counter the inflammation caused by the following injuries and conditions: arthritis (usually caused by damage or other wearing away of the cartilage lining in a joint); shoulder bursitis (caused by an inflammation of the bursa); finger, wrist, and elbow strains, including carpal tunnel syndrome; and knee and ankle sprains.

Cortisone also has a number of negative implications, especially in situations of long-term usage. Cortisone will tend to interfere in the vitamin D/calcium absorption process, fundamental to bone and tooth maintenance. This interference promotes general bone weakness. Cortisone also limits the development of collagen in bones. There are also concerns held throughout the sports medicine community that, when cortisone is injected into a joint already loosened by ligament damage, the joint will continue to create stresses on the remaining cartilage and accelerate further joint damage at the expense of immediate anti-inflammatory relief.

As importantly, long-term use of any anti-inflammatory may create a false sense of security on the part of an athlete. Medications such as cortisone are not a cure for an underlying structural problem that exists in a joint. If the anti-inflammatory becomes a substitute for corrective treatment of a joint injury, the damage to the joint may be increased. This concern is particularly acute in circumstances where the original injury was caused by repetitive strain such as pitching a baseball. The use of an anti-inflammatory, injected to permit the athlete to overcome the limitations of the inflammatory condition, may also accompany adjustments made by the athlete in his or her motion or delivery. This combination will sometimes result in the stresses of the repetitive motion to be redirected into another part of the immediate musculoskeletal structure, causing separate strain.

SEE ALSO Dose and dosage; Hormones; Musculoskeletal injuries.