Infection Risk and Safety of Corticosteroid Use

Rheum Dis Clin North Am. 2016 Feb;42(1):157-76, ix-x. doi: 10.1016/j.rdc.2015.08.004. Epub 2015 Oct 24.


Corticosteroids are frequently used to treat rheumatic diseases. Their use comes with several well-established risks, including osteoporosis, avascular necrosis, glaucoma, and diabetes. The risk of infection is of utmost concern and is well documented, although randomized controlled trials of short-term and lower-dose steroids have generally shown little or no increased risk. Observational studies from the real world, however, have consistently shown dose-dependent increases in risk for serious infections as well as certain opportunistic infections. In patients who begin chronic steroid therapy, vaccination and screening strategies should be used in an attempt to mitigate this risk.

Keywords: Bacterial infections; Corticosteroids; Opportunistic infections; Rheumatic diseases.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Bacterial Infections
  • Glucocorticoids / adverse effects*
  • Herpes Zoster / chemically induced*
  • Herpes Zoster / immunology
  • Herpes Zoster / prevention & control
  • Humans
  • Immunocompromised Host*
  • Mass Screening
  • Opportunistic Infections / chemically induced*
  • Opportunistic Infections / immunology
  • Opportunistic Infections / prevention & control
  • Pneumonia, Pneumocystis / chemically induced*
  • Pneumonia, Pneumocystis / immunology
  • Pneumonia, Pneumocystis / prevention & control
  • Rheumatic Diseases / drug therapy*
  • Tuberculosis / chemically induced*
  • Tuberculosis / diagnosis
  • Tuberculosis / immunology
  • Tuberculosis / prevention & control
  • Vaccines / therapeutic use


  • Adrenal Cortex Hormones
  • Glucocorticoids
  • Vaccines