Steroids, or corticosteroids, are available orally, as an injection, and as a topical. However, they come with serious risks and side effects, such as diabetes and glaucoma.

Rheumatoid arthritis (RA) treatment usually includes antirheumatic drugs (DMARDs) combined with nonsteroidal anti-inflammatory drugs and low-dose steroids.

Steroids are technically called corticosteroids or glucocorticoids. They’re synthetic compounds similar to cortisol, a hormone your adrenal glands produce naturally. Steroids can be taken orally, by injection, or applied topically.

Steroids are often used to help an individual with symptoms before they are given DMARDs or to help with severe flare-ups. When used in this way, the steroid treatment should be given for the shortest amount of time possible at the lowest effective dose.

Oral steroids come in pill, capsule, or liquid forms. They help reduce the inflammation levels in your body that make your joints swollen, stiff, and painful. They also help manage your autoimmune system to suppress flare-ups.

However, there is some evidence that steroids may lead to bone thinning and other side effects.

Common types of steroids used for RA include:

  • prednisone (Deltasone, Sterapred, Liquid Pred)
  • hydrocortisone (Cortef, A-Hydrocort)
  • prednisolone
  • dexamethasone (Dexpak Taperpak, Decadron, Hexadrol)
  • methylprednisolone (Depo-Medrol, Medrol, Methacort, Depopred, Predacorten)
  • triamcinolone
  • dexamethasone (Decadron)
  • betamethasone

Dosage

A low dose of oral steroids may be prescribed for early RA, along with DMARDs or other drugs. This is because DMARDs take 3 to 12 weeks to show results. But steroids act quickly, and you’ll see their effect in a few days.

After other drugs become effective, it’s important to taper off the steroids. This is usually done slowly, in small increments. The tapering helps prevent withdrawal symptoms.

Steroids can simply be discontinued if they were taken for less than 21 days.

The usual dose of prednisone is 5 to 10 mg daily. It’s recommended that you do not take more than 10 mg of prednisone per day. Daily supplements of calcium (800 to 1,000 mg) and vitamin D (400 to 800 units) are recommended.

Steroids are usually taken when you wake up in the morning. This is when your body’s own steroids become active.

A slightly higher dose of steroids may be used in RA when there are severe complications.

A 2020 review found that glucocorticoids are used in around 50 percent of people with RA. In some cases, people with severe RA become dependent on steroids long term in order to perform everyday tasks.

Steroids can be safely injected by a doctor into joints and the areas around them for pain and swelling relief. This can be done while you are maintaining your other prescribed drug treatment.

The American College of Rheumatology notes that in early RA, steroid injections into the most involved joints can provide local and sometimes systemic relief. This relief may be dramatic but is not lasting.

It’s recommended that injections into the same joint not be done more than once every 3 months. Moreover, repeated injections may increase cartilage loss.

Dosage

Your doctor may also use a local anesthetic when giving you a steroid injection.

The dose of methylprednisolone is usually 40 or 80 mg per milliliter. The dose may vary depending on the size of the joint that is being injected.

For example, your knee might require a larger dose, up to 80 mg. But your elbow may need only 20 mg.

Topical steroids are often used by people with arthritis for local pain relief. They can be either over-the-counter or prescription.

Topical steroids may lead to:

  • thin skin
  • poor wound healing
  • easy bruising
  • broken blood vessel
  • stretch marks

In order to avoid this, you may consider applying a retinoid cream at the same time.

Keep in mind that topical steroids are not recommended or mentioned in the American College of Rheumatology’s RA guidelines.

Steroid use in RA treatment is controversial because of the documented risks involved.

Significant risks include:

  • Cardiovascular issues. A 2020 study found that even low doses of glucocorticoids increased the risk of cardiovascular diseases.
  • Osteoporosis. Osteoporosis induced by long-term steroid use is a major risk.
  • Mortality. Some studies suggest that mortality might be increased with steroid use.
  • Cataracts. Research has shown an increased risk of cataracts for people taking steroids, even when given in low doses.
  • Diabetes. Long-term use of glucocorticoids is associated with the development of new-onset type 2 diabetes.
  • Infections. Taking steroids can lead to an increased risk of serious infections, even in small doses.
  • Gastrointestinal (GI) issues. People taking glucocorticoids are also at an increased risk of GI tract issues, like bleeding, gastritis, and gastric ulcer formation.

The risks increase with long-term use and higher dosages.

Side effects from steroid use in RA treatment can include:

  • adrenal insufficiency
  • blood sugar spikes
  • osteoporosis
  • weight gain, specifically around the face
  • cataracts
  • glaucoma
  • high blood pressure
  • mood swings

Check with a doctor when side effects are troubling or occur suddenly. It is especially important to monitor your blood sugar if you have diabetes.

Steroids in low doses can be part of a treatment plan for RA to relieve symptoms. They work fast to relieve inflammation and pain.

However, you should carefully consider the known hazards of steroid use, even at a low dose.

Talk with a doctor about all your treatment plan possibilities, including biologics. Weigh the pros and cons of each treatment and drug combination and make sure all your questions are answered.