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Corticosteroids: Benefits & Risks

Steroids can work wonders on your arthritis pain and inflammation - but they aren't without drawbacks.

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No doubt, corticosteroids (also called glucocorticoids or simply steroids) can help you feel better quickly. But with their strong anti-inflammatory and immunosuppressive action come some downsides. You and your doctor will need to discuss the risks and benefits before taking steroids, and you’ll want to learn some tricks to help lessen the potential side effects. 

The Benefits of Corticosteroids

Inflammation Reduction. Whether you rub them on, drop them into your eyes, take them by mouth, or have them injected, steroids reduce inflammation – and the accompanying pain – quickly and well.

If you have an inflammatory form of arthritis, like rheumatoid arthritis (RA), psoriatic arthritis (PsA), lupus or ankylosing spondylitis (AS), corticosteroids can be taken to get inflammation under control while you’re waiting for disease-modifying antirheumatic drugs (DMARDs) or biologics to take full effect. They can also be taken in low doses over longer periods of time and an adjunct to your other medicines.

Dangerous, system-wide inflammation that threatens your organs can be brought under quick control with intravenous corticosteroids.

Psoriasis and uveitis can  be managed with steroid creams and eye drops.

Although osteoarthritis (OA) may not be typically thought of as an inflammatory form of arthritis, there is an inflammatory component to the disease. That’s why steroid injections into a joint with OA can give fast, temporary relief.

Disease Modification. By suppressing the immune system in people with autoimmune forms of arthritis, corticosteroids can alter the course of your disease. Studies over the years have shown clear evidence that long-term, low-dose corticosteroid therapy slows disease progression in rheumatoid arthritis (RA) by at least 50% when given to people early in their disease course. A nighttime-release formulation of prednisone has been developed that counteracts the body’s natural nighttime rise in proinflammatory chemicals that contributes to disease activity.

Mood Alteration. Corticosteroids have been known to have an effect on your mood. This can be good or bad depending on how you react to the drug. For some people, they provide a sense of well-being. Or they can make you rather manic. For other people, the effect is opposite. The medication can make them depressed or give them mood swings. Generally, these mood effects occur in the first few weeks of treatment, then diminish.

The Risks of Corticosteroids

Short-Lived Benefits. The benefits of steroid medications on symptoms often do not last. A joint injection will greatly relive your pain and inflammation, but will last only 1-3 months depending on the specific medicine injected. When taken by mouth, corticosteroids must be taken daily for their effect. Your dose may be adjusted up or down depending on your symptoms.

Immunosuppression. A reduction of your body’s over-active immune response may be a wanted benefit of corticosteroids if you have RA or lupus. However, this same effect can leave you vulnerable to infections and can slow the healing process after an injury or surgery.

Withdrawal. Once you start taking corticosteroids, your body’s adrenal gland slows down production of your naturally occurring cortisol. Your body becomes dependent on the steroids you take. So discontinuing corticosteroid therapy may be difficult, even if you take only low doses. It can be dangerous to stop taking steroids abruptly. Your doctor will taper you off of the medication slowly.

Side Effects. A host of other side effects can occur when you take corticosteroids. Most of these are related to how much medicine you take and for how long you take it. Short-term use and low doses result in mild, controllable side effects. Some of the most common ones include:

  • Increased appetite, weight gain
  • Water retention, swelling
  • Mood swings
  • Restlessness, difficulty sleeping
  • Muscle weakness
  • Blurred vision
  • Increased growth of body hair
  • Easy bruising
  • Lower resistance to infection
  • Round, "puffy" face
  • Acne
  • Osteoporosis
  • Elevated blood sugar
  • High blood pressure
  • Stomach irritation
  • Cataracts or glaucoma
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