Steroids and the Treatment of Rheumatoid Arthritis
Like many other people with rheumatoid arthritis (RA), steroids have played a role in my treatment regimen. When I was 12 years old, I had a bad flare that affected my lungs and heart. IV steroids saved my life. All these years later, steroids are still helping me, but now it is through occasional steroid injections when my body needs some extra help.
What are steroids?
Steroids (or corticosteroids) are drugs that resemble the hormone cortisol, which your body produces naturally in your adrenal glands. Steroids decrease inflammation and suppress the immune system. Examples of steroid medication include cortisone, prednisone, and methylprednisolone. They are not the same as anabolic steroids, which are sometimes used illegally in sports.
Steroids can be a valuable tool to prevent progression of diseases that involve inflammation, including for instance vasculitis and myositis, and inflammatory arthritis. When someone experiences inflammation in the kidneys, steroids can be used to prevent progression into kidney failure.
However, steroids also have the potential for side effects, some of them serious, which need to be considered before using them in treatment.
How steroids are used for RA
People with RA may be treated with steroids in several different ways. For some, a low dose of steroids (5 mg a day) is part of their everyday treatment. In this case, the steroid can increase the effects of other DMARDs used to control the disease. Some doctors also consider steroids one of the safer drugs to control active RA in pregnant women.
Steroids can also be used during flares. In these cases, a temporary use of higher doses in what’s called a “burst” can help suppress the flare, allowing the person to recover. A burst consists of a short-term higher dose of steroids, which is then gradually tapered away. Steroids are always tapered as stopping “cold turkey” can cause withdrawal symptoms and possibly impact your adrenal gland.
These types of medications can also be given in injections directly into the joint or a bursa, a muscle or the tissue surrounding a tendon, or as a systemic steroid shot, usually giving in your buttocks or your upper arm. Steroid injections usually don’t hurt too much, as the steroid is often mixed with a local anaesthetic. Injections may be preferred, as there is less risk of side effects.
Steroids can also be used in creams for skin conditions, and as inhalers for asthma and other lung issues.
Common side effects and how to manage them
Side effects are usually more often associated with oral steroids. They may cause retention of fluids, which can increase blood pressure. Steroids are also linked to an increased risk of osteoporosis, easy bruising, and difficulty sleeping. They are an appetite stimulant and notorious for being associated with weight gain. It’s quite normal to develop a round face or “moon face” while on this medication. Some people also experience emotional side effects, having increased irritability, anxiety, and mood swings.
Although steroid injections are usually less likely to cause side effects, they may include injection area irritation and, if you receive repeated injections in the same joint, bone erosion may be a concern.
To manage side effects from oral steroids, it is recommended that these only be used when necessary, at the lowest effective dose, and that they are discontinued as soon as possible. If it is necessary to use them for a longer period, it’s important that you take calcium and vitamin D, and depending on the dose, possibly prescription medication to build bone.
Are steroids for you?
As with so many other things in life, the use of steroids is a balance. You have to assess the potential beneficial effects against the possibility of side effects. Rheumatologists differ in their acceptance of steroids. Some doctors won’t use them at all, others will use them sparingly, and a third group believe that for some patients, the benefits make steroids a valuable tool in quest for quality of life.
You may wish to talk to your rheumatologist about steroids so both of you can be on the same page should there be a time when using them might be relevant. Discuss the pros and cons, side effects, as well as any other medical conditions you may have to get a fuller picture of whether steroids could play a role in your treatment.
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Lene writes the award-winning blog The Seated View. She’s the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.