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Corticosteroids for Rheumatoid Arthritis

Examples

Generic NameBrand Name
dexamethasoneDecadron
methylprednisoloneDepo-Medrol, Medrol
prednisolone 
prednisone 
triamcinoloneAristospan

These medicines can be taken by mouth (orally). Shots (injections) of steroids into the joint may be used to relieve pain and swelling in a joint.

How It Works

Corticosteroids are medicines similar to natural hormone substances produced by the body that help to reduce inflammation. They are effective in reducing disease activity in rheumatoid arthritis.

One way corticosteroids reduce inflammation is by decreasing the action of the body's immune response. Although this effect can help relieve pain and swelling, it may make you more susceptible to infection.

Why It Is Used

Corticosteroids are used to control inflammation caused by rheumatoid arthritis.

Corticosteroids are used:

  • In low doses to control inflammation as "bridge therapy" when starting disease-modifying antirheumatic drugs (DMARDs) until the DMARDs become effective.
  • To treat sudden flares of joint pain.
  • For short-term relief (weeks to months) in inflamed joints.
  • In low doses for longer periods, for people who do not respond to other DMARDs.
  • For severe symptoms such as inflammation of the sac around the heart (pericarditis) or the blood vessels (vasculitis).

How Well It Works

Use of corticosteroids has been found to be effective in reducing inflammation caused by rheumatoid arthritis. Corticosteroids are usually used at the lowest dose and for the shortest amount of time possible.1

Corticosteroid shots into inflamed joints can relieve pain and increase function for some people. This relief may last from weeks to months.2 In general, the same joint should not be injected more than once every 3 or 4 months.

Side Effects

Serious side effects often occur when corticosteroids are used for long periods of time. These include:

Uncommon and irreversible (permanent) side effects, such as:

  • Softening or destruction of the hip, knee, wrist, or foot joint (osteonecrosis).
  • Cataracts.

Common and irreversible (permanent) side effects, such as:

Common and reversible (will disappear after discontinuing steroids) side effects, such as:

  • Swelling caused by fluid retention (edema).
  • Weight gain.
  • Rounding of facial features.
  • Mood swings, difficulty concentrating, insomnia, anxiety, euphoria.
  • Easy bruising.
  • Increased risk of infection from immune suppression.
  • Elevated blood pressure.
  • Problems with blood sugar levels (diabetes).
  • Muscle weakness.
  • Glaucoma.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Long-term use of corticosteroids is not recommended because of their serious side effects.

To prevent osteoporosis while taking long-term corticosteroids, get plenty of calcium and vitamin D, and consider a preventive medicine, such as alendronate or risedronate. To come up with a plan that fits your needs, you may want to work with your doctor or a registered dietitian. Weight-bearing exercise also helps reduce the risk of osteoporosis. For more information, see the topic Osteoporosis.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Lipsky PE (2008). Rheumatoid arthritis. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 2083–2092. New York: McGraw-Hill.
  2. Firestein GS (2007). Rheumatoid arthritis. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 2. New York: WebMD.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
Last Revised June 5, 2012

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