Corticosteroids for rheumatoid arthritis

Examples

Generic Name Brand Name
dexamethasone  
methylprednisolone Depo-Medrol, Medrol
prednisolone  
prednisone  
triamcinolone Aristospan

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

How It Works

Corticosteroids are medicines 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.

Why It Is Used

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.

How Well It Works

Use of corticosteroids in low doses has been found to be effective in reducing inflammation caused by rheumatoid arthritis. One study showed that 2 years of continuous low-dose prednisolone therapy slowed the progression of joint damage.1 High-dose corticosteroids given once a month may be helpful for some people.2

Corticosteroid shots into inflamed joints can relieve pain and increase function for some people.3 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.

Side Effects

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:

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.)

What To Think About

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.4

Joints often become inflamed again after corticosteroids are discontinued unless DMARDs are also used.4

To prevent osteoporosis while taking long-term corticosteroids, get plenty of calcium and vitamin D, and consider a preventive medicine, such as alendronate or risedronate. To come up with a plan that fits your needs, you may want to work with your doctor or a registered dietician. Weight-bearing exercise also helps reduce the risk of osteoporosis. For more information, see the topic Osteoporosis.

Weight-bearing exercise, adequate calcium and vitamin D intake, and certain medicines (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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References

Citations

  1. Pisetsky DS, St Clair EW (2001). Progress in the treatment of rheumatoid arthritis. JAMA, 286(22): 2787–2790.
  2. Lipsky PE (2008). Rheumatoid arthritis. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 2083–2092. New York: McGraw-Hill.
  3. Firestein GS (2007). Rheumatoid arthritis. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 2. New York: WebMD.
  4. Kwoh CK, et al. (2002). Guidelines for the management of rheumatoid arthritis. Arthritis and Rheumatism, 46(2): 328–346.

Last Updated: August 18, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Anne C. Poinier, MD - Internal Medicine & Stanford M. Shoor, MD - Rheumatology

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