Steroids for Rheumatoid Arthritis
Introduction
Steroids, which are also known as corticosteroids, are basically synthetic medications or drugs that closely resemble cortisol, which is a hormone naturally produced by the body. Steroids are used to treat various medical conditions since they work by decreasing inflammation and also leads to a reduction in the immune system activity. One should not confuse steroids with anabolic steroids. Anabolic steroids are used by athletes to achieve and build bigger muscles.
Steroids are mainly used for the treatment of inflammatory disorders such as blood vessel inflammation or inflammation in the muscles. They can be also used for other conditions such as rheumatoid arthritis, lupus, or gout.
The following are common corticosteroid medications:
- Cortisone - can be taken orally, inhaled, applied to the skin, or via injection
- Prednisone or prednisolone (Orapred or Prelone) - taken by mouth
- Triamcinolone (Kenalog) - given intravenously
- Methylprednisolone (Solu-Medrol) - given intravenously
- Dexamethasone (Decadron) - taken by mouth
Cortisone
Cortisone is known to suppress inflammation, which damages body tissues. This medicine is widely used for treating numerous medical conditions including rheumatoid arthritis. It is often referred to as a corticosteroid and belongs to a class of glucocorticoid drugs.
Apart from arthritis, cortisone is used for treating problems related to the skin, lupus, eye problems, and certain types of cancer. Cortisone is available in pill form and injection. It can also be inhaled or applied to the skin. To administer a cortisone injection, the doctor can inject the medicine directly into the area of inflammation. After the injection, the fatty tissues around the site of injection may look a bit sunken. However, this is only a temporary side effect and would go away on its own.
A rheumatologist can administer the injection directly into the joints to treat the problem of joint inflammation. Before taking this medicine, you should inform the doctor if you have any medical conditions such as thyroid problems, diabetes, liver or kidney disease, mental illness, depression, osteoporosis, stomach ulcers, hypertension (high blood pressure) or heart-related disorders. Do not stop taking this medicine without the consent of your doctor since you may experience withdrawal symptoms.
Certain side effects of cortisone are sleeping problems or insomnia, acne, headache, dizziness, nausea, bloating stomach, sudden mood changes, easy bruising, stomach pain, and excessive sweating. However, the drug also has serious side effects, which include seizures, sudden weight, coughing up blood, irregular breathing or shortness of breath, swelling, bloody stools, and a sudden rise in blood pressure. You should consult a doctor immediately if you experience some of the serious side effects for proper diagnosis and treatment. Cortisone can also interact with certain drugs such as aspirin, insulin, rifampin, and ketoconazole.
Prednisolone
Prednisolone is a man-made form of a natural substance, which is made by the adrenal gland. This medicine has been used to treat various medical conditions including eye conditions, irregular breathing, arthritis, blood-related problems, and severe types of allergies. Prednisolone decreases the response of the immune system, thereby leading to a reduction of symptoms such as swelling, pain, or allergic reactions.
This medicine has to be taken orally with food to avoid having an upset stomach. The dosage should be taken exactly as prescribed by the doctor. Moreover, carefully measure the dose before taking it. There are various brands available in different strengths. The doctor can prescribe taking prednisolone 1-4 times a day or it can be a single dose every other day. You should not stop taking this medication without consulting your doctor since it can lead to withdrawal symptoms or may worsen your existing condition. The doctor can gradually decrease the strength of the dose.
The side effects of prednisolone include nausea, headache, dizziness, drowsiness, having trouble sleeping, changes in menstrual periods, acne, and extensive sweating. If any of these side effects tend to worsen after a couple of days, then it is better to consult your doctor immediately.
Since this drug tends to weaken the immune system, the body's ability to fight off infections would also get weak. It can lead individuals falling for serious types of infections or may worsen their existing condition. For these reasons, if you notice signs of infection such as fever, cough, chills, or a sore throat, then consult your doctor right away. Moreover, avoid using this medicine for a longer duration since it can lead to oral thrush or yeast infections. Contact your doctor if you see white patches in your mouth or if you notice an unusual change in vaginal discharge. Rare and serious prednisolone side effects include internal bleeding in the stomach or intestines.
Before taking prednisolone, it is best to inform your doctor about your past and current medical histories such as (hypertension) high blood pressure, liver or kidney diseases, heart-related problems, diabetes, internal bleeding problems, blood clotting issues, tuberculosis, or thyroid problems. There are certain drugs that can interact with prednisolone, and they include aldesleukin, mifepristone, drugs that can weaken the immune system, medications that can lead to internal bleeding, blood thinners, and anti-inflammatory drugs such as aspirin or ibuprofen.
Methylprednisolone
Methylprednisolone is taken orally in the form of a tablet. Methylprednisolone is also available in the form of a suspension or solution. However, you need a doctor's prescription to get this drug. It is also available in generic forms. However, these type of drug is not usually available in every strength or form.
Methylprednisolone is used to treat a lot of medical conditions since it helps control the inflammation in the body and also modifies the immune system. Methylprednisolone is a part of the glucocorticoid class of drugs. The main purpose of this class of drugs is to reduce the inflammation by modifying the immune system of the body, which, in turn, causes a reduction in inflammation.
The side effects of methylprednisolone can lead to liver damage. However, it would be a minor side effect, and can be reversed once the person stops taking the medication. The following are the most common side effects of methylprednisolone:
- Confusion
- Excitement
- Sudden weight gain
- Swelling in the ankles, feet, or hands
- Increased thirst
- Increased risk of developing infections
- Hypertension or high blood pressure
- Depression
- Muscle weakness
If these side effects are not very severe, then they would go away in a couple of days or weeks. If it worsens, then consult the doctor immediately. The serious type side effects of this drug include the following:
- Allergies that lead to skin rashes
- Swelling of the face, lips, or tongue
- Sudden mood changes leading to anxiety
- Personality changes
- Vision problems
- Diabetes leading to a frequent urge to urinate
- Signs of infection such as coughing, fever, or a sore throat
- Loss of appetite
- Skin irritation
You should avoid taking drugs such as cyclosporine, troleandomycin, and ketoconazole along with methylprednisolone as these medications can cause drug interactions. Drugs such as phenytoin, phenobarbital, and rifampin can also cause a decrease in the effectiveness of methylprednisolone.
How do they work?
As previously mentioned, steroids are known to decrease inflammation, and at the same time, reduce the activity of the immune system. The process of inflammation is the way by which the body's white blood cells and chemicals protect the body against any kind of infection or foreign organisms such as fungus, virus, or bacteria. In certain cases of illness, the body's defense mechanism does not function the way it is supposed to and becomes overactive, leading to inflammation and working against the body's own tissues, thereby causing damage to the tissues.
Inflammation is characterized by certain signs such as warmth, redness, pain, and swelling. Steroids work by reducing the production of inflammatory chemicals to minimize tissue damage. Apart from this, steroids are also known to reduce the activity of the immune system by affecting the normal functioning of the white blood cells.
Corticosteroids are used in controlling inflammation caused by arthritis:
- Corticosteroids in low doses can help control the inflammation and act as a bridge therapy until disease-modifying antirheumatic drugs or DMARDs become effective.
- They are given to treat sudden flares of joint pain.
- They can also be used for the short-term treatment of inflamed joints.
- In cases where individuals do not respond to DMARDs, this medicine is given in low doses for a longer duration.
How are they given?
Steroids are available in the form of topical creams or ointments or through injections. It can also be given orally. Injections can be directly administered at the site of inflamed joints or bursa, muscles, tendons, and other soft tissues.
Steroid Injections
In certain cases, the doctor can inject steroids into one or two areas of inflammation. This would allow the doctor to deliver a higher dose directly to the inflamed area. When steroids are given orally or through intravenous method, the doctors would be unsure of the adequate amount, which will eventually reach the affected area. Moreover, there is a higher chance of developing side effects if drugs are given via mouth or IV method.
In most cases of rheumatoid arthritis, doctors intend to give steroid injections directly into the joints to get the problematic area sorted. The medicine can also be injected into the inflamed bursa or around the tendon area, which is near the joints in the body. Steroid injections are often well-tolerated by most individuals and are less likely to cause any side effects compared to other forms of steroid administration. Moreover, by taking steroid injections, you can avoid the risk of taking increased dosages of oral steroids, which could cause more harm since the side effects would also increase.
Benefits
When vital body organs are threatened due to inflammation, steroids can help save them by preventing the progression of certain diseases. An example would be kidney inflammation, which ultimately leads to kidney failure in people who are suffering from lupus and diabetes. For these people, steroid therapy can help eliminate their need for dialysis or kidney transplant.
Steroids are usually given in low doses, which can help individuals to get relief from stiffness and pain, especially for those who are suffering from rheumatoid arthritis. Even if steroids are given on a temporary basis, it can still help the person recover from a severe case of arthritis flare-ups.
Side Effects
If corticosteroids are taken for a longer duration, then it can lead to the following side effects:
- Permanent side effects - are side effects that cannot be reversed. They include eye cataract, destruction of the hip or foot joint and thinning or weakening of the bones leading to osteoporosis.
- Temporary side effects - these side effects can be reversed once the medicine is stopped. They include easy bruising, mood changes, edema that leads to swelling caused by fluid retention, weight gain, hypertension (high blood pressure), glaucoma, weakening of the muscles, and an increased risk of developing infections due to a suppressed immune system.
