Corticosteroids for Rheumatoid Arthritis
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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
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.
- 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
- For short-term relief (weeks to months) in inflamed
- 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
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.
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).
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
- Weight gain.
- Rounding of facial
- Mood swings, difficulty concentrating, insomnia, anxiety,
- Easy bruising.
- Increased risk of infection
from immune suppression.
- Elevated blood
- Problems with blood sugar levels (diabetes).
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
To prevent osteoporosis while taking long-term
corticosteroids, get plenty of
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
Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.
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.
Firestein GS (2007). Rheumatoid arthritis. In DC Dale,
DD Federman, eds., ACP Medicine, section 15, chap. 2.
New York: WebMD.
Anne C. Poinier, MD - Internal Medicine
Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
June 5, 2012