High levels of cortisone in the body produce several other problems over time. Skin damage can occur, resulting in skin sores known as calcinosis cutis, thinning of the skin and hairloss. Suppression of the immune system occurs, making bacterial infections more likely. Increased drinking and urination can become a problem. Muscular weakness can occur.
Pancreatitis is more common in dogs on long term cortisone therapy.
These side effects are minimized but not completely eliminated by every other day use of prednisone. In any situation in which long term use of prednisone is anticipated, these things must be considered as possible side effects. These effects are probably more important than the adrenal suppression in most patients. Despite all of this, I will use prednisone on a daily basis when it is the best medication for older dogs with arthritis, especially when they are at or near the point where the owners would consider euthanasia without the benefits of the medication. My reasoning in this instance is that side effects may take a long time to develop into a problem and any time past the time euthanasia is being considered is better than none.