Whether taken by mouth, topically, intravenously, or injected into a joint, steroids relieve inflammation fast.
Corticosteroids are also called glucocorticoids or steroids. Sometimes people use the name of a specific type – like cortisone or prednisone – when referring to the whole class of drugs. No matter what you call them, they are potent anti-inflammatories. But don’t confuse them with anabolic steroids, which some athletes take to enhance their performance.
The original corticosteroid – cortisone – was considered a miracle drug when it was first used in 1949 to treat rheumatoid arthritis. Corticosteroids reduce inflammation because they are chemically similar to cortisol, one of your body’s natural anti-inflammatories. Although their popularity has decreased over the years due to negative side effects, they still play an important role in managing arthritis symptoms. And they may even have disease-modifying effects for some types of arthritis.
Corticosteroids are both anti-inflammatory and immunosuppressive (meaning they reduce the activity of the immune system). They can be used to treat rheumatoid arthritis (RA), osteoarthritis, lupus, asthma, allergies, and to prevent organ rejection in transplant recipients.
Inflammation can take place in your joints, tendons, organs, and skin, depending on the type of rheumatic disease you have. Doctors may prescribe corticosteroids for fast, temporary relief while waiting for disease-modifying antirheumatic drugs (DMARDs) or Biologics to take full effect. They also are useful for people if their disease is not well controlled with nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, or biologics.
Some rheumatic diseases – like RA, lupus, and psoriatic arthritis (PsA) – happen when your immune system attacks your own body’s tissues and organs. In these cases, the immunosuppressive effects of corticosteroids may be therapeutic. They can help by decreasing harmful autoimmune activity. However, this can leave you susceptible to infection and can slow down the healing process.
Your body naturally makes less cortisol at night and arthritis symptoms often get worse overnight – resulting in morning stiffness. An extended-release corticosteroid formulation has been developed that can counteract the nighttime rise in proinflammatory chemicals that contributes to disease activity.
A slow-release injectable corticosteroid has also been developed recently that can extend the efficacy of joint injections.
How They’re Given
Depending on the arthritis symptoms your doctor is trying to control, corticosteroids can be given in a variety of ways.
- Topical. Creams and ointments can help heal many skin conditions, including psoriasis of PsA.
- Ophthalmic. Steroid drops for the eye can be used to treat uveitis.
- Oral. Tablets, capsules or syrups help treat the inflammation and pain associated with RA, lupus, ankylosing spondylitis, PsA, and other rheumatic diseases.
- Intra-articular. Steroids can be injected directly into the joint to quickly relieve pain and inflammation of RA, OA, tendinitis, bursitis, etc.
- Intramuscular. Injections into the muscle can be given if you have multiple inflamed joints, if you need longer-acting relief than can be gotten with oral medication, and to avoid nausea that some people have when taking pills by mouth.
- Intravenous. In cases when severe, system-wide inflammation threatens your organs, your doctor may recommend injecting high doses of corticosteroids directly into your vein. This can protect your kidneys, nervous system, and brain from dangerous inflammation.
Types of Corticosteroids
- Betamethasone (Celestone, Celestone Soluspan; cream, injection)
- Cortisone acetate (generic only; tablet)
- Dexamethasone (Baycadron, Dexamethasone Intensol, DoubleDex, generic; tablet, injection)
- Difluprednate (Durezol; eye drops)
- Fluorometholone (Flarex, FML Forte, generic; eye drops)
- Hydrocortisone (Cortef, Cortaid, generic; tablet, cream, suspension)
- Loteprednol etabonate (Lotemax, Alrex; eye drops)
- Methylprednisolone (Medrol, Solu-Medrol, A-Methapred, Depo-Medrol, generic; tablet, injection)
- Prednisolone (Millipred, Orapred ODT, Pediapred, Veripred, generic; tablet, syrup)
- Prednisolone acetate (Pred Forte, Omnipred, Econopred, generic; eye drops)
- Prednisone (Deltasone, Prednisone Intensol, Rayos, generic; syrup, tablet)
- Triamcinolone (Kenalog, generic; cream, injection)
- Triamcinolone acetonide (Zilretta; extended-release injection)