CORTICOSTEROIDS

Corticosteroids are some of the oldest, most effective and fastest-working drugs for many forms of arthritis. When used properly and sparingly, corticosteroids have the power to spare joints, eyes and internal organs from damaging inflammation. In some cases, they even save lives. Unfortunately, they also have the potential to do great harm by causing brittle bones, cataracts and elevated blood sugar – particularly if they are taken in high doses or for long periods of time.

Cortisone may be injected directly into the joint to relieve severe inflammation and swelling. A cortisone injection can provide almost immediate relief for a tender, swollen or inflamed joint. However, since corticosteroids can degrade cartilage and demineralize the bone, they should only be used rarely. Chronic use of corticosteroids may result in weight gain, hypertension, susceptibility to infection, capillary fragility, acne, excess hair growth, cataracts, glaucoma, diabetes, muscular atrophy, accelerated atherosclerosis, menstrual irregularities, irritability, insomnia and psychosis. Since steroids appear to cause premature death of osteoblasts and slow their replacement; osteoporosis and bone damage are of particular concern. Long-term use may also affect brain cells, causing memory loss. Certain side effects such as hypoglycemia, edema and hypertension can be minimized by treatment.

To maximize benefits and minimize side effects, such as weight gain, mood swings and thining skin, doctors prescribe corticosteroids in doses as low as possible and for as short of a time as possible. Dosages vary widely and are based on your disease and the goals of treatment. For example, low doses – 10 mg of prednisone or less – may be sufficient for the joint inflammation associated with RA, whereas much higher doses would be needed to control lupus-related kidney inflammation. Injections of corticosteroids directly into inflamed joints may help control localized inflammation, but this chart lists corticosteroids given orally to treat widespread, systemic inflammation.

By prescribing DMARDS, such as methotrexate, sulfasalazine (Azulfidine) or leflunomide (Arava) along with corticosteroids, many doctors find they can keep dosages of corticosteroids low. In some cases, DMARDs or a biologic agent such as adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel) or infliximab (Remicade) may eliminate the need for corticosteroids entirely.