Health Library Corticosteroids for Rheumatoid ArthritisFrom Healthwise

These medications can be taken by mouth (orally). Shots (injections) of steroids into the joint may be used to relieve pain and swelling in a joint.

Corticosteroids are medications similar to natural hormone substances produced by the body that help to reduce inflammation. They are effective in reducing disease activity in rheumatoid arthritis.

One way corticosteroids reduce inflammation is by decreasing the action of the body's immune response. Although this effect can help relieve pain and swelling, it may make you more susceptible to infection.

Corticosteroids are used to control joint inflammation caused by rheumatoid arthritis.

Corticosteroids are used:

• In low doses to control inflammation as "bridge therapy" when starting disease-modifying antirheumatic drugs (DMARDs) until the DMARDs become effective.
• To treat sudden flares of joint pain.
• For short-term relief (weeks to months) in inflamed joints.

Use of corticosteroids in low doses has been found to be effective in reducing inflammation caused by rheumatoid arthritis.¹ One study showed that 2 years of continuous low-dose prednisolone therapy slowed the progression of joint damage.² Other studies report that at least 3 months of treatment with low-dose oral corticosteroids significantly reduces pain and joint inflammation while improving joint function.¹

Corticosteroid shots into inflamed joints can relieve pain and increase function for some people. This relief may last from weeks to months. In general, the same joint should not be injected more than once every 3 or 4 months.

Serious side effects often occur when corticosteroids are used for long periods of time. These include:

Uncommon and irreversible (permanent) side effects, such as:

• Softening or destruction of the hip, knee, wrist, or foot joint (osteonecrosis).
• Cataracts.

Common and irreversible (permanent) side effects, such as:

• Bone thinning and weakening (osteoporosis).

Common and reversible (will disappear after discontinuing steroids) side effects, such as:

• Swelling caused by fluid retention (edema).
• Weight gain.
• Rounding of facial features.
• Mood swings, difficulty concentrating, insomnia, anxiety, euphoria.
• Easy bruising.
• Increased risk of infection from immune suppression.
• Elevated blood pressure.
• Problems with blood sugar levels (diabetes).
• Muscle weakness.
• Glaucoma.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Corticosteroids often provide rapid, dramatic relief of pain and inflammation caused by rheumatoid arthritis. Long-term use is not recommended, however, because of their serious side effects.³

Joints often become inflamed again after corticosteroids are discontinued, unless DMARDs are also used.³

Women past menopause are at increased risk for osteoporosis and should consider the increased risk of bone thinning (osteoporosis) with steroid use. Osteoporosis can lead to increased risk of bone fractures throughout the body. A person taking corticosteroids to treat rheumatoid arthritis will need to take 1500 mg of calcium and 400 to 800 IU of vitamin D daily, often along with other medications to prevent osteoporosis.

Weight-bearing exercise, adequate calcium and vitamin D intake, and certain medications (most often bisphosphonates such as alendronate or risedronate) may help reduce the risk of bone thinning. For more information about osteoporosis, see the topic Osteoporosis.

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Citations

1. Emery P, Suarez-Almazor M (2002). Rheumatoid arthritis. Clinical Evidence (10): 1454–1476.

2. Pisetsky DS, St Clair EW (2001). Progress in the treatment of rheumatoid arthritis. JAMA, 286(22): 2787–2790.

3. Kwoh CK, et al. (2002). Guidelines for the management of rheumatoid arthritis. Arthritis and Rheumatism, 46(2): 328–346.

Author:	Robin Parks, MS	Last Updated: August 23, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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