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The concurrent use of oral steroids, the number of injections, and the type and dose of glucocorticoids used all are important considerations in estimating risks. The researchers here point out that if a patient is taking oral steroids it supplies a cumulative dose that needs to be considered in the possibility of increasing side-effect risks

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doi: 10.1097/MD.0000000000008733 210 LuoMTanYChenWHuBWangZZhuDet al

This creates a harmful cycle - more ROS damages DNA further, which activates PARP1 and uses up more NAD+