Whether taken by mouth, topically, intravenously, or injected into a joint, steroids relieve inflammation fast.
Corticosteroids reduce inflammation because they are chemically similar to cortisol, one of your body’s natural anti-inflammatory hormones, made in the adrenal glands. Although their popularity has decreased over the years due to the introduction of newer drugs with fewer side effects, they still have a role in managing some arthritis symptoms.
Corticosteroids are both anti-inflammatory and immunosuppressive, meaning they reduce the activity of your immune system. Doctors often prescribe them for fast, temporary relief while waiting for disease-modifying antirheumatic drugs (DMARDs) or biologics to take full effect or during a severe flare of symptoms.
How They’re Given
You can be prescribed corticosteroids in several ways.
• Topical. Creams and ointments are used to treat various skin conditions, including psoriasis that occurs with psoriatic arthritis (PsA).
• Ophthalmic. Steroid eye drops are often the best way to bring down inflammation in uveitis.
• Oral. Tablets, capsules or syrups may help reduce inflammation and pain in people with RA and lupus. (Oral steroids should not be used for PsA, however; they can trigger severe forms of the disease.)
• Intramuscular. Your doctor might suggest a one-time injection into a muscle if you need longer-acting relief than oral medication can provide.
• Intravenous (IV). IV steroids might be used to treat a severe disease flare, but they’re not intended for intermittent use.
• Intra-articular. An injection of a corticosteroid (sometimes combined with a local anesthetic) directly into an individual joint can reduce inflammation and pain due to arthritis. The effect may last for several months, but repeated injections can increase cartilage loss.
Benefits and Risks
Corticosteroids are the fastest and most efficient way to control inflammation. The trade-off is a range of side effects – some very serious. To reduce the risk of side effects, your doctor will usually prescribe a low dose for a short amount of time (three months or less). The longer you take the medication and the higher the dose, the greater the risk. Long-acting versions are more likely to cause side effects, too, especially adrenal suppression, which means your own adrenal glands stop making cortisol. Some people develop side effects after just a few doses, and some changes, such as diabetes and eye damage, may be permanent. Be sure you understand all the risks and benefits before starting any type of steroid therapy.
Corticosteroids work quickly and effectively, which is why they’re often used for a short time until other medications kick in or to stop a disease flare in its tracks. In cases of severe systemic inflammation, they can be life-saving. Corticosteroids shouldn’t be used long-term to treat inflammatory arthritis – or any disease – but they’re sometimes used for a few weeks or months to boost the effectiveness of DMARDs or other drugs.
Side Effects and Solutions
Altered Response to Physical Stress
If you take corticosteroids for more than two weeks -- even if you then wean yourself off the medication -- your adrenal glands may become sluggish, and your body may not be able to respond normally to physical stress. This is called adrenal insufficiency, and it may last up to a year after you stop the medication. It’s potentially life-threatening because you’re not able to respond normally to a serious illness, surgery or an injury.
Solution: If you’re taking corticosteroids or have taken them in the past year, be sure to tell your dentist, doctor and any providers treating you in any emergency or during surgery. In such cases, your doctor’s likely to give you supplemental or “stress steroids” to make up for any adrenal insufficiency.
Blood Sugar Changes
A spike in blood sugar is a common side effect of corticosteroids; it’s often seen within hours of your first dose. Blood sugar usually returns to normal once you stop the medication, but some people develop permanent diabetes.
Solution: Work closely with your doctor to monitor your blood sugar level. If it’s too high, you may need medication to bring it down. If you already have diabetes, your doctor will try to find an alternative to steroid therapy.
Bone Loss and Bone Death
Bone loss (osteoporosis) may be one of the most serious consequences of corticosteroid therapy; thin, brittle bones can lead to fractures. Another problem, bone death (osteonecrosis), can occur as well.
Solution: Daily, weight-bearing or resistance training exercise such as walking, jogging or weight lifting is critical to keeping bones strong. Additionally, the American College of Rheumatology recommends getting between 1,000 mg to 1,200 mg of calcium and 600-800 IU of vitamin D every day; some people at moderate- to high-risk of fractures may need to take osteoporosis medication. Also, quit smoking, eat a balanced diet, limit alcohol consumption and maintain a healthy weight.
Corticosteroids affect the way your body stores and uses fat. You may notice a swollen face (“moon face”) and increased fat on the back of your neck and around your middle.
Solution: Watch calories and exercise regularly to help prevent weight gain. Reduce your salt intake because it can cause you to retain fluid. Most people lose the extra pounds once they come off steroids, though it can take up to a year to get your former self back.
Cataracts and Glaucoma
Corticosteroids can increase your risk of cataracts (the clouding of your eye’s lens) and glaucoma (the buildup of pressure in your eye, which can lead to vision loss).
Solution: You should have a complete eye exam by an ophthalmologist before starting steroids and regular eye exams during and after you take them. Some eye damage can’t be reversed, so it’s important to catch it early.
High Blood Pressure
The hormone cortisol helps regulate the balance of water, sodium and other electrolytes in your body. When you take corticosteroids, you may retain excess fluid leading to a corresponding spike in blood pressure.
Solution: A low-sodium diet’s the best way to control your blood pressure. Look for low-salt versions of prepared foods, chips, canned soups and salad dressings or avoid them altogether. Your doctor should check your blood pressure often. Tell your doctor right away if you notice swollen ankles or other signs you’re retaining water.
Corticosteroids suppress your immune system, making you more vulnerable to infection. Even minor infections can become serious.
Solution: Wash your hands often and stay away from crowds and people you know are sick. If you notice any signs of infection – a fever, cough or painful urination – call your doctor right away.
People rarely think of corticosteroids as mood-altering drugs, but in fact, they can cause a rollercoaster of emotions, ranging from agitation, anxiety, aggression or mania to deep depression.
Solution: Mood problems are much more common with high doses. Be sure to tell you doctor about your symptoms. Exercise, yoga, deep breathing and meditation might be helpful.
Both topical and oral corticosteroids affect your body’s ability to produce collagen, the main structural protein in skin. This can lead to very thin skin as well as poor wound healing, easy bruising, broken blood vessels and stretch marks. Some of these symptoms aren’t reversible.
Solution: There’s little you can do to prevent thin skin, especially if it results from oral corticosteroids. But if you use topical steroids, applying a retinoid cream at the same time might help prevent some thinning.
Steroids can cause a host of other side effects, including:
• Blurred vision, eye pain or trouble reading
• Irregular pulse or heartbeat
• Numbness or tingling in your arms or legs
• Pounding in your ears
• Shortness of breath or trouble breathing when you’re not active
• Trouble peeing, thinking or walking
Taking a few precautions before, during and after you use corticosteroids that can help prevent some serious problems.
• Steroids increase your risk of infection so you might want to consider a flu shot before you start the medication. Avoid all immunizations while on steroids unless your doctor recommends otherwise. You also need to stay away from anyone who has had a live virus vaccine, like measles, mumps, rubella or polio; you could catch the virus from them.
• In the past, steroids were linked to birth defects, low birth weight and premature delivery. Later studies haven’t found increased risks in pregnant women. To be safe, you may still want to use an effective birth control method.
• Insomnia is a common side effect of corticosteroids, so you may want to talk to your doctor about taking the whole dose in the morning.
• Steroids can interact with hundreds of medications. Be sure to tell your doctor all the prescription and over-the-counter drugs you take. You may need to stop some of them or find another type of anti-inflammatory.
• Side effects of corticosteroids can persist long after you stop taking them so continue seeing your doctor regularly.
Russell AS. Why Oral Corticosteroids Should Not be Used in Patients with Rheumatoid Arthritis.
Smith HR. Rheumatoid Arthritis Medication.
Mayo Clinic Staff. Cortisone shots.
Saltsman K. Long-term Benefit of Steroid Injections for Knee Osteoarthritis Challenged.
Clifton Bingham III, MD, director of Johns Hopkins Arthritis Center. Personal Communication. Liu D, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.
Fields TR. Steroid Side Effects: How to Reduce Corticosteroid Side Effects.
Mayo Clinic Staff. Prednisone (Oral Route).
Chambers CD. Safety of corticosteroids in pregnancy: Is it the drug or the disease?
The Johns Hopkins Vasculitis Center. Prednisone.
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