Steriods, also known as corticosteroids or glucocorticoids, are widely used in the treatment of several disorders like arthritis, asthma, allergy, etc. Judiciously used, these drugs are important weapons in the treatment of rheumatic arthritis (RA). In fact, the discovery of steroids culminated in Dr. Philip Showalter Hench and his colleagues Edward C. Kendall and Tadeus Reichstein being awarded with the Nobel Prize more than 60 years ago.
Are steroids the only drugs for treating RA?
No, steroids are one of the four groups used to treat RA. The other groups include anti-inflammatory drugs (commonly called pain killers), disease modifying anti-rheumatic drugs (DMARDs) and biologics. Often, doctors combine drugs from each of these groups.
Do all RA patients require steroids?
No, the decision to use steroids in RA patients is taken on a case-by-case basis. Conditions No two RA patients are alike. Some have mild disease while others have more severe disease. The decision to use steroids takes into account several things like disease duration, disease severity, complications, etc.
Are all steroids alike?
Steroids include several drugs like prednisolone, methyl prednisolone, dexamethasone, deflazacort, etc. There are minor differences in the different agents. Prednisolone is the most common agent used. Low dose steroid treatment differs from high dose treatment in terms of side effects, and possibly, mechanism of action.
How are steroids given?
Steroids can be given as tablets, injections, creams, eye drops, etc.
When are steroids used in RA?
Your doctor, who has evaluated your particular case, is the best person to decide this.
- In general, the current standard of care for early RA (disease duration of less than two years) is a combination of methotrexate with low dose prednisolone, used for one to two years.
- Steroids used in early RA reduce joint damage and do more good than harm. Steroids in early RA are always combined with drugs like methotrexate and never used as sole agents.
- In people who have established RA (disease duration of more than two years), steroids can be used to treat disease flares when the joint pains and inflammation aggravates.
- In case of severe joint swelling like fluid in the knee, the doctor may inject steroids directly into the joint.
- Sometimes, steroids are used to treat RA during pregnancy & breastfeeding, when several of the other drugs cannot be used.
Once on steroids, will I stay on it for life?
No, the treatment duration and dosages vary according to the situation. In most situations, steroids can be tapered and stopped altogether.
Why are steroids feared?
The indiscriminate use of large doses, often by quacks, is responsible for this public perception. Never take steroids without a doctor’s prescription.
How can side effects be minimised?
The important thing is to use steroids under strict medical supervision. The lowest dose for the shortest possible time should be used in consultation with your doctor. The drugs are not bad, improper use is. In patients on long term steroids, calcium and vitamin D pills are supplemented to protect bones.
What are the side effects of steroids?
Some of the side effects associated with long term use in high doses are:
- Weight gain
- Increase in blood sugar
- Worsening of blood pressure
- Increase in facial hair
All the side effects may not come up in one patient. Steroid users may develop one, many or none of these side effects. Why some people develop side effects while others escape them is not known. Generally, low doses given for short periods are not associated with major adverse effects.