Steroids, or corticosteroids, can help relieve inflammation. Since rheumatoid arthritis (RA) is an inflammatory autoimmune disorder, steroids are often one part of the treatment plan.

Different steroid types exist, each with specific benefits and side effects. The corticosteroids that help treat RA are not the same as the steroids an athlete might take to build muscle. Typically, a doctor prescribes steroids for short-term use to reduce flare-ups or while waiting for other medicines to work. In this article, learn more about steroids for treating RA, including the different types, possible side effects, and what to ask a doctor.

Types

Steroids are medicines that mimic the activity of hormones in the body. The body's adrenal glands, located above the kidneys, produce natural steroids. Pharmaceutical manufacturers can create steroids that have similar actions and can suppress the body's immune system. This can help treat RA, as the disease causes the immune system to attack the body's synovial joints.

Examples of steroids a doctor might prescribe to treat RA include:

• Dexamethasone
• Methylprednisolone
• Prednisolone
• Prednisone

Some of these steroids are more potent or longer-lasting than others. A doctor will consider a person's symptoms when determining which medicine to prescribe. In addition to different medications, there are different preparations of corticosteroids available, such as:

• Intra-articular injections, which is an injection that goes directly into the joint
• Intramuscular injections, which go into the muscles
• Intravenous (IV) injections, which go into the veins
• Oral medications, such as pills or capsules

A doctor will consider a person's symptoms, where the symptoms occur, and their medical history when recommending different preparations.

Uses

Doctors can prescribe steroids:

• To reduce RA symptoms while a person is waiting for disease-modifying anti-rheumatic drugs (DMARDs) or biologics to work
• To reduce pain and discomfort when a person is experiencing a flare-up
• To reduce symptoms when other medications have not proven effective
• To reduce or lessen the extent of heart and blood vessel damage due to RA

Dosage

The correct dosage will depend on the desired effect and the person's overall health. Larger dosages are more likely to produce a faster effect than lower ones. A typical dose of prednisone is usually around 5–10 milligrams (mg) per day, although some people may take more.

While steroids can initially improve symptoms and mask the effects of RA at first, taking steroids for a prolonged time will not permanently stop the disease's progression. For this reason, doctors usually prescribe steroids at high dosages for a short time to achieve more immediate effects or at lower dosages for a longer time to help minimize side effects.

Side effects

A doctor should discuss the potential side effects of steroids as a treatment for RA. Some of the possible side effects include:

• Fragile skin that tears or bruises easily
• Greater risks for infections
• High blood pressure
• High blood sugar
• Fatigue
• Increased risk of cataracts
• Leg swelling
• Mood changes
• Problems sleeping
• Weakness
• Weight gain

Not everyone will experience all or any of the side effects above. As a general rule, the longer a person takes steroids, the more likely they are to have side effects. Effects of taking steroids for extended periods can include an increased risk of:

• Diabetes
• Heart problems
• Obesity

These side effects are less likely with intra-articular steroid injections. A doctor may recommend slowly increasing the dosage when starting to take the corticosteroids and tapering the dosages over time. If a person takes steroids regularly and suddenly stops taking them, they may experience hypotension (low blood pressure) and dizziness.

Additional RA treatments

Steroids are not the only treatment option for people with RA. Doctors may prescribe other medications or a combination that includes:

• Non-steroidal anti-inflammatory drugs (NSAIDs): These medications include over-the-counter drugs, such as ibuprofen and naproxen, as well as stronger prescription drugs. NSAIDs reduce inflammation and minimize pain in the joints
• DMARDs: These medications suppress the body's immune system, but can take weeks to months to start working. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil)
• Biologic agents: Biologic agents modify the body's response to inflammation and reduce the risk of tissue damage. Examples include abatacept (Orencia) and etanercept (Enbrel)

In addition to medications, doctors may recommend physical and occupational therapy to maintain flexibility in the joints. If RA causes severe joint damage, a doctor may suggest surgical procedures to remove the damaged joint portions and minimize joint pain.

What to ask a doctor

Whenever someone starts taking a new medication, they should ask their doctor or a pharmacist about what results and side effects they can expect. There are several different steroids on the market, so if a person is concerned about the side effects of one, there may be another one or a lower dose a doctor could prescribe. Some questions a person could ask if their doctor prescribes steroids include:

• What kind of results can I expect when taking steroids?
• How long do you anticipate I will need to take steroids?
• Am I taking the lowest possible effective dose?
• Are there measures I can take to reduce the likelihood I will experience side effects?

Summary

Steroids are a useful and important type of medicine doctors use to help treat RA. Most people with RA will likely need to take steroids at some point in the course of the disease. Having an understanding of side effects and benefits can help a person get the best results for their overall health. It is best to speak to a doctor about any adverse side effects of steroids or concerns that the medication is not working.