**4. Side effects of systemic glucocorticoids**

Toxicity of GCs is one of the most common causes of iatrogenic illness associated with chronic inflammatory disorders. The side effects of GCs have been known for decades. But the exact risk-benefit ratio is incomplete and/or inconsistent, because usually it is difficult to differentiate the effects of GCs from the effects of the underlying accompanying diseases, other comorbidities,

### **Onset early in therapy, essentially unavoidable**


### **When supraphysiologic treatment is sustained**


• Insomnia



**Delayed and insidious, probably dependent on cumulative dose**

**Table 3.** The most common and serious side effects of GCs (adapted from [56]).

or the other medications. GCs associated side effects are dependent on both the average dose and the duration of therapy. Overall, it can be stated that prolonged application is a high-risk factor, whereas total dose is of secondary importance. Even in low-dose therapy, GCs could lead to serious side effects. The severity ranges from more cosmetic aspects (e.g. teleangiectasia, hypertrichosis) to serious disabling and even life-threatening situations (e.g. gastric hemorrhage). Single or multiple side effects can occur [12, 54, 55]. The side effects of GCs are the major limiting factor for the use of these agents. An overview of the most common and serious side effects of GCs is summarized in **Table 3**.
