Glucocorticoids (Steroids)

Glucocorticoids, also commonly called corticosteroids or steroids, are drugs used to relieve inflammation, as well as to reduce swelling, redness, itching, and other allergic reactions.¹ Glucocorticoids are often prescribed to patients with rheumatoid arthritis (RA) to reduce pain and inflammation and assist with the regulation of autoimmune activity in the body.²

Glucocorticoids can be very effective in treating the symptoms of RA, but these medications are potent and are typically used in short-term situations. Also, glucocorticoids are often prescribed along with other treatments such as nonsteroidal anti-inflammatory medications (NSAIDs) or disease-modifying anti-rheumatic drugs (DMARDs). Unlike DMARDs, glucocorticoids reduce inflammation, but cannot work to protect the joints and organs from permanent damage.²

Glucocorticoids come in different forms, such as:³

• Tablets (oral steroids)
• Injections
• Inhalers (such as nasal sprays)
• Solutions
• Lotions, gels, or creams (topical steroids)

Glucocorticoids are usually prescribed in oral or injection form for the treatment of RA. Common glucocorticoids prescribed for RA include:²

• Dexamethasone (brand name Decadron^®)
• Methylprednisolone (brand names Depo-Medrol^® and Medrol^®)
• Prednisolone
• Prednisone
• Triamcinolone (brand name Aristospan^®)

Uses of glucocorticoids

Glucocorticoids work quickly and well to relieve the pain and inflammation associated with RA.⁴ Oral forms are usually taken as pills, once daily and in small doses. Morning doses are most common, as steroids mimic the body’s natural increase in activity. Morning doses can also help to relieve stiffness upon waking.²

Injectable glucocorticoids deliver the medication directly to the inflamed area, and therefore can be highly effective. Injections are typically delivered several months apart, for a maximum of three or four injections per year.²

Because DMARDs can take several weeks to begin working, glucocorticoids are often prescribed along with DMARDs, to provide immediate pain relief until the DMARDs take effect. In addition, they may be prescribed to relieve pain and inflammation during flare-up periods. Some doctors may prescribe very low doses of glucocorticoids for long-term use, where others prefer to limit the use of the drug.^2,4

How glucocorticoids work

Glucocorticoids imitate your body’s response to hormones that are produced naturally in your adrenal glands. When you take glucocorticoids in an amount higher than what is naturally produced in your body, this can suppress inflammation, reducing pain and swelling associated with RA.

However, glucocorticoids also suppress your body’s immune system, which is why you should be aware of possible risks and side effects of glucocorticoid use. By following your doctor’s directions and taking these medications as prescribed, you can help prevent serious side effects and make sure that the benefits of this treatment outweighs the risk.⁵

Possible side effects

Side effects from glucocorticoids are more likely when these medications are used long-term-particularly with oral options.^2,3 Glucocorticoid injections do not produce as severe side effects as their oral counterparts. However, they can produce additional side effects not associated with glucocorticoid pills.²

Common side effects from oral glucocorticoids include:^2,3

• Nausea
• Vomiting
• Increased risk of ulcers
• 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
• Increased appetite or weight gain
• Skin that bruises easily
• Diabetes
• Osteoporosis
• Acne

Injection therapy may also contribute to skin irritation or rashes at the site of injection.² This is not an exhaustive list of all potential side effects of glucocorticoids. For more information, consult your doctor or healthcare provider.

Other things to know

If you experience side effects while taking glucocorticoids, it is important that you do not stop your medication abruptly. Talk to your doctor, as you could experience unpleasant withdrawal effects. Your doctor may advise a slow and steady reduction of medication over time.³

Injected glucocorticoids are usually safe for most people. While tablets are more likely to cause negative effects, short-term use with the lowest dose necessary can safely work to reduce pain and inflammation caused by RA. However, certain patients may be at greater risk for side effects with oral glucocorticoid use. Such patients include:³

• Those with ongoing, widespread infection
• Those suffering from mental health issues, such as depression or alcohol dependence
• Those with liver problems, heart failure, high blood pressure, or diabetes
• Those taking medications that may interact with glucocorticoids

Long-term use of glucocorticoids may also contribute to more severe problems such as:⁶

• Shrinking of the adrenal glands, which stops the body’s natural production of corticosteroid
• Adrenal necrosis of the hips—a painful condition that may require surgery

If you are being prescribed glucocorticoids to treat your RA symptoms, be sure to disclose any other medicines you are taking and let your doctor know if you experience any side effects.