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 Ricks
Benefits and Risks
Side Effects and Solutions
Altered Response to Physical Stress
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
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
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.
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
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
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.
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.
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.
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.
• 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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