Steroids (full name corticosteroids) are very effective in reducing inflammation and so are often prescribed for people with rheumatoid arthritis (RA). They can be taken in four main forms:
- daily tablets
- by injection into individual joints
- by injection into a muscle (thigh or buttocks)
- in a solution given intravenously as a drip over 1-2 hours (often called a pulse).This is rarely used for RA these days.
People are often prescribed a steroid in one form or another to overcome the initial symptoms of RA and/or while other medication eg disease modifying anti-rheumatic drugs (DMARDs) take effect. Higher doses can also be prescribed for short periods to help people overcome a flare of their RA.
Steroid tablets (Prednisolone)
Several people we talked to were taking or had taken a steroid daily and this ranged from a few months to 42 years. People described the effects of steroids as decreasing pain, increasing mobility, making them feel more lively, but some were unsure of their effect.
Steroid tablets used to be prescribed more readily before the problems of long-term, higher dosage use were well known. People who were taking them regularly had often reduced the dosage, over time, to a minimum to still keep their symptoms at a bearable level but described the difficulties in safely reducing the dose. One woman’s doctor was happy for her to control her steroid tablets within limits during a flare.
Describes the effects of steroid tablets and reducing the dose over time.
A woman who had side effects from DMARDs found steroids the only medication that would work. Several people said they were worried about the unwanted effects and would prefer not to take them; one woman chose to stop taking steroids (over time) in favour of taking more painkillers. However one woman felt that the improved quality of life it gave her was worth the risks.
Thinks the benefit of a better quality of life from taking steroids daily outweigh the risks.
People mentioned a number of short-term side effects, including nausea/vomiting, headaches, mood swings and flatulence. Longer term effects known to occur include weight gain and puffiness, particularly of the face, which one woman described. Skin becomes thin and delicate and is then easily injured or bruised. Steroids also reduce bone density leading in time to osteoporosis. Bone density scanning (See Regular monitoring and other diagnostic tests) can identify those at risk and some people took a calcium supplement or had increased the amount of calcium in their diet to improve their bone density. In children and teenagers high doses of steroid can interfere with growth.
Steroids made her gain weight.
Taking steroids for 42 years made her skin thin and fragile.
A bone scan identified early osteoporosis but now she takes calcium and her bone density has not…
One woman felt that after taking steroids for about 8 years she couldn’t make decisions effectively and felt her head was a fug and as if theres a blanket wrapped round your brain and you had to fight to get anything out of it, but when she stopped taking them she could again make quick decisions.
Steroid Joint injections
Steroid can be injected directly into particularly painful or inflamed joints (in flare). People we talked to had received injections into different joints, most commonly the knee but all of the following were mentioned hips; ankles; toes; shoulders; elbows; wrists; fingers and the jaw. Several people found these injections painful or very painful and decided not to have any more; options to reduced discomfort include use of vryogesic (freezing spray which makes the skin cold and numb just while the injection is being performed) or local anaesthetic can be used to numb the skin completely to reduce discomfort. Fluid may be drawn out (aspirated) from the joint via a needle immediately before a steroid injection to help improve the symptoms.
Different people described the effect of the injections as brilliant, helpful, reducing the pain for a while, calms down the joint and not a lot. However, one womans hands were worse after injections into her fingers. In some the joint injection solved the problem and the pain disappeared, in others the effects lasted from 2-3 weeks to approximately two months or more when some had repeat injections.
Has had injections into various joints with varying effects.
Doctors may use imaging equipment to help them to inject the steroid into the correct point, eg. into the hip. One man had pins and needles after a wrist injection and one woman who had her jaw injected said the anaesthetic had paralysed her face for some hours after the injection.
Injections are sometimes available at short notice via the Rheumatology clinic and some people could phone and have one later that week.
Can ring the Rheumatology clinic and request injections if joints are particularly painful.
Steroid Pulses (methyl-prednisolone intravenous drips)
Many people we interviewed had in the past received a steroid pulse when their symptoms were worse. The steroid solution is infused over 1-2 hours via a cannula inserted into a hand or arm vein. This usually involved a 2-3 hour hospital visit but some people had had 2 or 3 pulses over 2-3 days. This treatment is very rarely used now.
Steroid pulses helped him get over a flare but the effects didn’t last long.
Depo-Medrone (slow-release methylprednisolone) injections
Depo-Medrone injections into muscle are similar in effect to pulses. For a few people this was the main medication every few weeks or months. However, most people described them as a back-up or safety net that they would have only 3-4 times a year. One woman felt they worked better than the steroid pulses. These are used routinely at the beginning of treatment, as a bridge until the DMARDs start to work, and to reduce short-lived flares.