Corticosteroids for Rheumatoid Arthritis

Rheumatoid arthritis treatment consists of a variety of medications. Most patients pursue of a combination of medications including disease-modifying antirheumatic drugs (DMARDs), biologics, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

Corticosteroids are a highly-effective but potent drug for treating rheumatoid arthritis inflammation and pain. They are used in short-term situations and may not be appropriate for all patient cases.

What are Corticosteroids?

Corticosteroids are steroidal medications given to rheumatoid arthritis patients to reduce inflammation and help regulate autoimmune activity. Corticosteroids have been used over five decades to help treat rheumatoid arthritis symptoms. Often times you will hear corticosteroids referred to as glucocorticoids.

Many rheumatoid arthritis treatment strategies still use corticosteroids in combination with NSAIDs and DMARDs because they not only reduce inflammation but they can also help protect joints and organs from future damage.

How do Corticosteroids Work?

The human body naturally produces cortisol hormones from adrenal glands that reside above the kidneys. Corticosteroids mimic these hormones’ effects on the body, and when prescribed in a high enough dosage, they reduce inflammation in the patient.

Corticosteroids prescribed to rheumatoid arthritis patients reduce the levels of inflammation that cause joint pain, stiffness, and bone and cartilage deterioration. Corticosteroids also act as immune inhibitors by suppressing autoimmune attacks that cause inflammation in rheumatoid arthritis patients.

Besides rheumatoid arthritis, corticosteroids are used to treat a number of inflammatory and autoimmune disease such as lupus, asthma, skin conditions, and a variety of allergies.

Types of Corticosteroids for Rheumatoid Arthritis

There are several types of corticosteroids for rheumatoid arthritis. They are sometimes also called glucocorticoids.

Here are the common forms of corticosteroids used to treat rheumatoid arthritis symptoms:

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depo-Medrol, Medrol)
  • Prednisolone
  • Prednisone
  • Triamcinolone (Aristospan)

Prednisone is the most commonly used corticosteroid in treating rheumatoid arthritis.

How are Corticosteroids for Rheumatoid Arthritis Administered?

Corticosteroids treatments for rheumatoid arthritis are available in several formats. These formats include:

  • Pills (tablets, capsules and syrups)
  • Intra-articular injection (into the joint)
  • Intravenous injection
  • Intramuscular injection

The pill formats of corticosteroids are usually taken orally once daily in smaller doses. Most types of corticosteroids are taken when the patient wakes up in the morning. This is because the steroids mimic the body’s own natural increase in activity. Patients also take corticosteroids upon wakening to alleviate symptoms of morning stiffness.

Intra-articular steroid injections are proven to be highly effective as they deliver the drug directly into the inflamed area. Corticosteroid injections are typically delivered several months apart. Doctors may recommend that patients only receive a maximum of three or four corticosteroid injections per year.

Usually, corticosteroids are prescribed in a low dosage for a short period of time. Because corticosteroids are so potent, it is best to slowly and gradually reduce the dosage over several weeks to prevent symptoms of withdrawal. This is as opposed to stopping taking corticosteroids abruptly, which can sometimes cause negative reactions in patients.

When to Take Corticosteroids for Rheumatoid Arthritis

Corticosteroids are typically taken in conjunction with DMARDs. For most patients, DMARDs can take weeks to begin working. In this time, it’s important to try and get the disease under control as much as possible. Using corticosteroids during this waiting period is a highly effective method of reducing inflammation and helping alleviate pain and stiffness for the patient.

Corticosteroids may also be prescribed during periods of flare-ups, whereby the disease becomes highly active and severe symptoms appear. Corticosteroids are used to quiet down the symptoms and provide immediate relief for patients.

In general, corticosteroids are viewed as a “bridge therapy” option for treating rheumatoid arthritis patients. This means that they are used in select cases for a short period of time at smaller doses. This is primarily due to the number of severe side effects associated with corticosteroid use.

In summary, here are how corticosteroids for rheumatoid arthritis are used:

  • As an interim treatment, or “bridge therapy” while waiting for DMARDs to take effect
  • During painful flare-ups when inflammation becomes active
  • As short-term inflammation and pain relief
  • Over longer periods of time in low doses for patients not responding to DMARDs
  • For serious inflammation symptoms affecting the heart and blood vessels

Side Effects of Corticosteroids

Though corticosteroids can be very effective at reducing inflammation and alleviating pain, they do carry many serious side effects. Side effects from corticosteroids are more likely to occur when they are used as regular treatment over a longer period of time. This is why physicians try to limit the long-term reliance on corticosteroids for rheumatoid arthritis treatment.

Side effects of corticosteroids in rheumatoid arthritis patients may include:

  • Increased risk of viral or bacterial infection
  • Sudden withdrawal symptoms like weakness and fatigue
  • High blood pressure
  • Increased blood sugar
  • Swelling in legs
  • Risk of cataracts
  • Weight gain
  • Mood disruption including depression and anxiety
  • Insomnia

Usually, intra-articular corticosteroid injections don’t produce as severe of side effects as oral corticosteroids produce. However, corticosteroid injections may produce separate side effects than oral corticosteroids. For example, many patients develop skin irritation and rashes at the injection site.

Today, many physicians choose to avoid using corticosteroids as a reliant rheumatoid arthritis medical treatment. Many doctors will try to minimize its use and eventually eliminate it completely from the medical treatment strategy.

Outcomes of Corticosteroids for Rheumatoid Arthritis

Rheumatoid arthritis patients taking corticosteroids will experience nearly immediate relief of symptoms. Corticosteroids target inflammation quickly, relieving the patient of pain and stiffness, which helps restore quality of life.

As a temporary and short-term medical treatment, corticosteroids usually provide a very positive outcome for rheumatoid arthritis patients and can help suppress the disease’s progression and preserve joint function.

In some situations, corticosteroids are prescribed to reduce inflammation in rheumatoid arthritis that has begun to impact vital organs. In these situations, corticosteroids can be critical and even life-saving.

Corticosteroids for rheumatoid arthritis are one element of an overall treatment strategy that is comprehensive and personalized to each patient.