Corticosteroids for rheumatoid arthritis

Examples

---

Generic Name

dexamethasone

Brand Name	Generic Name
Medrol	methylprednisolone

Brand Name	Generic Name
Medrol	prednisolone

Brand Name	Generic Name
Medrol	prednisone

Brand Name	Generic Name
Aristospan	triamcinolone

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 joint 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.

How Well It Works

---

Use of corticosteroids in low doses has been found to be effective in reducing inflammation caused by rheumatoid arthritis. One study showed that 2 years of continuous low-dose prednisolone therapy slowed the progression of joint damage.¹ High-dose corticosteroids given once a month may be helpful for some people.²

Corticosteroid shots into inflamed joints can relieve pain and increase function for some people.³ This relief may last from weeks to months. 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:

• Bone thinning and weakening (osteoporosis).

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

---

Corticosteroids often provide rapid, dramatic relief of pain and inflammation caused by rheumatoid arthritis. Long-term use is not recommended, however, because of their serious side effects.⁴

Joints often become inflamed again after corticosteroids are discontinued unless DMARDs are also used.⁴

Women past menopause are at increased risk for osteoporosis and should consider the increased risk of bone thinning (osteoporosis) with steroid use. Osteoporosis can lead to increased risk of bone fractures throughout the body. A person taking corticosteroids to treat rheumatoid arthritis will need to take of calcium and 400 to 800 IU of vitamin D daily, often along with other medicines to prevent osteoporosis.

Weight-bearing exercise, adequate calcium and vitamin D intake, and certain medicines (most often bisphosphonates such as alendronate or risedronate) may help reduce the risk of bone thinning. For more information about osteoporosis, 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. Pisetsky DS, St Clair EW (2001). Progress in the treatment of rheumatoid arthritis. JAMA, 286(22): 2787–2790.

2. 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.

3. Firestein GS (2007). Rheumatoid arthritis. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 2. New York: WebMD.

4. Kwoh CK, et al. (2002). Guidelines for the management of rheumatoid arthritis. Arthritis and Rheumatism, 46(2): 328–346.

Credits

---

Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	August 18, 2008