How are corticosteroids used to treat rheumatoid arthritis?

Corticosteroids, often just called steroids, provide quick relief from pain and inflammation. They may be used at high doses in combination with disease-modifying antirheumatic drugs (DMARDs) to quickly tamp down inflammation at the start of treatment. But as DMARDs begin to take effect, steroids are usually tapered down to very low doses and may eventually be discontinued entirely.

Direct corticosteroid injections can relieve acute flare-ups in painful joints, but for safety reasons, injections are generally limited to no more than a few a year.

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Also known as glucocorticoids, corticosteroids such as prednisone and methylprednisolone (Medrol) reduce inflammation and pain and may slow joint damage from rheumatoid arthritis (RA). Because they can cause dramatic improvements in a very short time, healthcare professionals often use them while waiting for DMARDs to kick in, and then may gradually discontinue use. They may be an option if your RA doesn't respond to NSAIDs and DMARDs. These medications also have serious side effects, especially at high doses, including increased bruising, thinning of bones, weight gain, onset or worsening of diabetes, cataracts, and a round face.

Rheumatoid arthritis can increase bone loss, leading to osteoporosis. This bone loss is more likely in people who use corticosteroids. To keep your bones as strong as possible, use the lowest possible dose of corticosteroids for the shortest amount of time, consume at least 1,000 to 1,200 milligrams of calcium and 400 to 1,000 IUs of vitamin D a day and talk to your doctor about medications called bisphosphonates, such as alendronate sodium (Fosamax) and ibandronate sodium (Boniva), that can help reduce bone loss.