Corticosteroid use and abuse by medical practitioners for arthritis and related disorders in Pakistan

Abstract

A total of 256 consecutive patients attending our out-patient clinic in Islamabad, Pakistan, with complaints of pain in or around the joints were evaluated for use of corticosteroids prescribed by medical practitioners they had seen earlier. The appropriateness of such prescriptions and their consequent effects were assessed. Of the 256 patients, 110 (i.e. 42.5%) were identified as steroid users; some of them were suffering from conditions known to be unresponsive to this form of therapy. One hundred and one of the 256 patients had rheumatoid arthritis and 67% of these had been using steroids, mostly in an irrational manner. The general practitioners and consultants (all non-rheumatologists) were responsible for the majority of steroid prescriptions. Steroid side-effects were observed in 42/110 (38.2%) cases. This prevalent practice in Pakistan is a reflection of the state of affairs in developing countries, and indicates a need for improvement and better regulation of health care in such countries.

Corticosteroid Nonprescription Use: A Cross-Sectional Hospital-Based Study in Basrah

“…Steroid-induced diabetes had been observed in 5 of 110 patients with arthritis and related disorders, treated by physicians in Pakistan [13] .…”

“…Because of its 'magic effect', it was used indiscriminately without prescription with resultant side effects, which can be very severe even if used in low doses [11][12][13][14] , as has been described in a review article of corticosteroid abuse and/or dependence driven by the euphoria these medications can induce [15] .…”

Use and misuse of glucocorticoids in the community of Raxaul Block, North Bihar

“…[4][5][6] A case study of a Pakistani man in United Kingdom and an article by a group of rheumatologists in Pakistan suggest the problem is spread across the Indian subcontinent. 7,8 In India, misuse of many drugs is a result of easy availability of drugs over the counter. This is compounded by a lack of awareness regarding the side effects, by both the patient and the prescriber.…”

Self-Medication of Corticosteroids: A Life Threatening Case Report from Pakistan

“…[3] Corticosteroids are among highly abused drugs, freely available at local medical stores without prescription in developing countries like Pakistan. [4] Being a potent anti-inflammatory drug, it is commonly prescribed, irrationally, by registered medical practitioners as well as by quacks for getting quick relief with the aim to ascertain their healing abilities-an attempt to satisfy customers for future visits. [4] By raising plasma glucose levels, corticosteroids provide the body with energy, it requires, to combat stress conditions like trauma, fright, infection, bleeding, or debilitating disease.…”

“…[4] Being a potent anti-inflammatory drug, it is commonly prescribed, irrationally, by registered medical practitioners as well as by quacks for getting quick relief with the aim to ascertain their healing abilities-an attempt to satisfy customers for future visits. [4] By raising plasma glucose levels, corticosteroids provide the body with energy, it requires, to combat stress conditions like trauma, fright, infection, bleeding, or debilitating disease. [5] Besides providing fruitful effects, it can cause unwarranted physiological changes, such as a modest rise in blood pressure, thromboembolism, necrotizing angititis, cardiac arrhythmias, myopathy, spontaneous fractures, glaucoma and immunosuppression.…”