Rheumatoid arthritis (RA) is a chronic inflammatory disease that makes the small joints of your hands and feet painful, swollen, and stiff. It’s a progressive disease that has no cure yet. Without treatment, RA can lead to joint destruction and disability.
Early diagnosis and treatment can help relieve symptoms and improve your quality of life with RA. Treatment depends on your individual condition.
Treatment plans usually include antirheumatic drugs (DMARDs) combined with nonsteroidal anti-inflammatory drugs and low dose steroids. Alternative treatments are also available.
Let’s take a closer look at the role steroids play in treating RA.
Steroids are technically called corticosteroids or glucocorticoids. They’re synthetic compounds similar to cortisol, a hormone your adrenal glands produce naturally. Until just over 20 years ago, steroids were the standard treatment for RA.
But these standards changed as the harmful effects of steroids became known and new types of drugs were developed. The current RA guidelines of the
However, these steroids are often needed to help a patient with symptoms before they are given DMARDs. When used in this way, the steroid treatment should be given for the shortest amount of time possible at the lowest effective dose.
Researchers voting on the RA guidelines felt that the toxicities experienced as a result of glucocorticoid use outweighed the benefits.
The associated side effects can be musculoskeletal, cardiovascular, gastrointestinal, or neuropsychiatric. Some may also cause infections or affect your eyes, metabolic and endocrine systems, or skin.
Many clinical trials now use the
Steroids can be taken orally, by injection, or applied topically.
Oral steroids come in pill, capsule, or liquid forms. They help reduce the inflammation levels in your body that make your joints swollen, stiff, and painful. They also help manage your autoimmune system to suppress flare-ups.
However, there is some evidence that steroids may lead to bone thinning and other side effects.
Common types of steroids used for RA include:
- prednisone (Deltasone, Sterapred, Liquid Pred)
- hydrocortisone (Cortef, A-Hydrocort)
- dexamethasone (Dexpak Taperpak, Decadron, Hexadrol)
- methylprednisolone (Depo-Medrol, Medrol, Methacort, Depopred, Predacorten)
- dexamethasone (Decadron)
Prednisone is the most used steroid in RA treatment.
A low dose of oral steroids may be prescribed for early RA, along with DMARDs or other drugs. This is because DMARDs take 3 to 12 weeks to show results. But steroids act quickly, and you’ll see their effect in a few days.
Steroids are sometimes referred to as bridge therapy.
After other drugs become effective, it’s important to taper off the steroids. This is usually done slowly, in small increments. The tapering helps prevent withdrawal symptoms.
The usual dose of prednisone is
Usually, steroids are taken when you wake up in the morning. This is when your body’s own steroids become active.
A slightly higher dose of steroids may be used in RA when there are severe complications.
In some cases, people with severe RA become dependent on steroids long term in order to perform everyday tasks.
Steroids can be safely injected by a doctor into joints and the areas around them for pain and swelling relief. This can be done while you are maintaining your other prescribed drug treatment.
In some cases, steroid injections have been effective in reducing the size of RA nodules, according to
It’s recommended that injections into the same joint not be done more than
The steroids commonly used for injection are methylprednisolone acetate (Depo-Medrol), triamcinolone hexacetonide, and triamcinolone acetonide, according to a 2008 review.
Your doctor may also use a local anesthetic when giving you a steroid injection.
The dose of methylprednisolone is usually 40 or 80 mg per milliliter. The dose may vary depending on the size of the joint that is being injected.
For example, your knee might require a larger dose, up to 80 mg. But your elbow may need only 20 mg.
Topical steroids are often used by people with arthritis for local pain relief. They can be either over the counter or prescription. But topical steroids are not recommended or mentioned in the
Steroid use in RA treatment is controversial because of the documented risks involved.
Significant risks include:
- Cardiovascular issues. A 2020 study found that even low doses of glucocorticoids increased the risk of cardiovascular diseases.
- Osteoporosis. Osteoporosis induced by long-term steroid use is a major risk, according to
- Mortality. Some studies
suggestthat mortality might be increased with steroid use.
- Cataracts. Research has shown an
increased riskof cataracts for people taking steroids, even when given in low doses.
- Diabetes. Glucocorticoids
have been associatedwith the development of new-onset type 2 diabetes.
- Infections. Taking steroids can lead to an
increased riskof both mild and life threatening bacterial or viral infections.
- Gastrointestinal (GI) issues. People taking glucocorticoids are also at an
increased riskof GI tract issues, like bleeding, gastritis, and gastric ulcer formation.
The risks increase with long-term use and higher dosages.
Side effects from steroid use in RA treatment include:
- weight gain
- rounded face, also known as moon face
- high blood pressure
- mood disruption, including depression and anxiety
- leg swelling
- easy bruising
- higher prevalence of fractures
- adrenal insufficiency
- lowered bone mineral density
Steroid injection side effects are rare and usually temporary. These include:
- skin irritation
- allergic reactions
- skin thinning
Check with a doctor when side effects are troubling or occur suddenly. Monitor your blood sugar if you have diabetes.
Steroids in low doses can be part of a treatment plan for RA to relieve symptoms. They work fast to relieve swelling and pain. But you should carefully consider the known hazards of steroid use, even at a low dose.
Talk with a doctor about all your treatment plan possibilities, including biologics. Weigh the pros and cons of each treatment and drug combination and make sure all your questions are answered.
Above all, RA treatment requires that you be proactive.