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 relieves symptoms and improves your quality of life with RA. Treatment depends on your individual condition. Treatment plans usually include disease-modifying antirheumatic drugs (DMARDs) combined with nonsteroidal anti-inflammatory drugs (NSAIDs), and low-dose steroids. Alternative treatments are also available, including the use of the antibiotic minocycline.
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 20 years ago, steroids were the standard treatment for RA.
But these standards changed as the harmful effects of steroids became known and as new types of drugs were developed. The current RA guidelines of The American College of Rheumatology now advise doctors to use the lowest possible amount of steroids for the shortest time.
Steroids can be taken orally, by injection, or applied topically.
Oral steroids come in pill, capsule, or liquid form. They help reduce the inflammation levels in your body that make your joints swollen, stiff, and painful. They also help regulate your autoimmune system to suppress flare-ups. There is some evidence that steroids reduce bone deterioration.
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 often 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 8-12 weeks to show results. But steroids act quickly, and you’ll see their effect in a few days. Steroids are sometimes referred to as a “bridge therapy.”
After other drugs become effective, it’s important to taper off the steroids. This is usually done slowly, in increments of 1 milligram (mg) every two weeks to a month. The tapering helps prevent withdrawal symptoms.
Usually, steroids are taken in the morning when you wake up. This is when your body’s own steroids become active.
A higher dose of steroids may be used in RA when there are severe complications.
A 2005 review of RA data found that 20 to 40 percent of people newly diagnosed with RA were using steroids. The review also found that up to 75 percent of people with RA used steroids at some point.
In some cases, people with severe (sometimes called disabling) RA become dependent on steroids long-term in order to perform everyday tasks.
Steroids can be safely injected by your doctor into joints and the area around them for pain and swelling relief. This can be done while you are maintaining your other prescribed drug treatment.
The American College of Rheumatology notes that in early RA, steroid injections into the joints most involved can provide local and sometimes systemic relief. This relief may be dramatic, but is not lasting.
In some cases, steroid injections have been effective in reducing the size of RA nodules. This provides an alternative to surgery.
It’s recommended that injections into the same joint not be done more than once in three months.
The steroids commonly used for injection are methylprednisolone acetate (Depo-Medrol), triamcinolone hexacetonide, and triamcinolone acetonide.
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, both over-the-counter and prescription drugs, are often used by people with arthritis for local pain relief. But topical steroids are not recommended (or mentioned) in the American College of Rheumatology RA guidelines.
Steroid use in RA treatment is controversial because of the documented risks involved.
Significant risks include:
- Heart attack: A 2013 review of people diagnosed with RA and taking steroids found a 68 percent increased risk for heart attack. The study involved 8,384 people who were diagnosed with RA between 1997 and 2006. Each 5 mg per day increase in dosage added to the risk.
- Osteoporosis: Osteoporosis induced by long-term steroid use is a major risk.
- Mortality: Some observational studies suggest that mortality might be increased with steroid use.
The risks increase with long-term use and higher dosages.
Side effects from steroid use in RA treatment include:
- increased risk of bacterial or viral infection
- weight gain
- rounded face, also called “moon face”
- increased blood sugar
- high blood pressure
- mood disruption, including depression and anxiety
- leg swelling
- easy bruising
- higher prevalence of fractures
- adrenal insufficiency
- lowered bone mineral density five months after a tapering course of 10 mg prednisone
Steroid injection side effects are rare and usually temporary. These include:
- skin irritation
- allergic reactions
- skin thinning
Check with your 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.
Read up on all the treatment possibilities, including biologics and the antibiotic minocycline. Weigh the pluses and minuses of each treatment and drug combinations. Discuss potential treatment plans with your doctor, and make sure all your questions are answered.
Above all, RA treatment requires that you be proactive.