Treatment with glucocorticoids (also called corticosteroids or steroids) are important tools in the treatment of rheumatoid arthritis (RA), primarily as an adjuvant (a term referring to treatment that is used as an adjunct) for treatment modifying the disease, for example, to combat rheumatism, including new biological treatments. In this article, glucocorticoids for rheumatoid arthritis are considered.  Causes of autoimmune diseases.

Glucocorticoids for rheumatoid arthritis

Glucocorticoids are powerful anti-inflammatory drugs that can be used to quickly control disease activity, such as inflammation. Since there is an increased risk of side effects with prolonged use, glucocorticoids are usually used as a “bridge” therapy in patients with active disease who have begun treatment, which may take 4 to 6 weeks to achieve full effect. Steroids are especially effective in providing rapid control of inflammation and related symptoms during outbreaks of RA.




As soon as the drugs take effect, steroids are usually conical (gradual dose reduction) and cease after control over the activity and symptoms of the disease has been achieved. Steroid treatment should be conical and should not be interrupted suddenly.

Glucocorticoids for rheumatoid arthritis

How steroids work

Glucocorticoids exhibit their strong anti-inflammatory and immunomodulating effects (changing the way the immune system works in a certain way), inhibiting the key cells of the immune system and chemicals that play a role in inflammation. They achieve their effect through several different mechanisms, most importantly, interfering with how genes work to synthesize key components of the immune system. Glucocorticoids are also considered immunosuppressants.  Early signs of RA.

How glucocorticoids are taken

Glucocorticoids for rheumatoid arthritis are available for oral administration, intramuscular injection, and infusion. Some common oral medications used in RA include prednisone, prednisolone, dexamethasone, and methylprednisolone. Some examples of steroids designed for injection or infusion include methylprednisolone and dexamethasone. Steroids can also be injected directly into the affected joints to reduce inflammation (synovitis). A long-acting steroid, such as triamcinolone hexacetonide, is often used for intra-articular steroid injections.



What evidence shows that glucocorticoids work

Short term use.

The effectiveness of short-term use (1 month or less) of steroids to combat disease activity has been demonstrated in a number of studies. One meta-analysis (an analysis that reviews the results of a number of studies) of 10 randomized trials, including 320 patients with RA, showed that low doses of prednisone (15 mg or less per day) resulted in a greater reduction in joint tenderness and pain than NSAIDs and placebo and a greater increase in strength than a placebo. Short-term use of glucocorticoid treatment at a low dose equivalent to prednisone 15 mg per day or less is associated with a very low risk of serious side effects.

Other studies have confirmed the benefits of short-term administration of high-dose glucocorticoids in early RA. Two studies (COBRA and BeST) found that prednisone starts at a rate of 60 mg per day, narrows to 7.5 mg per day for 6 weeks and stops at 12 weeks when it is received using conventional therapy, which prevents the progression of joint damage. In addition, this beneficial effect has been maintained for several years.



No studies to date have tested short-term intermediate doses (between low and high doses) of glucocorticoids in RA. Also, glucocorticoids were not directly associated with newer biological drugs.  Muscle and joint stretching exercises.

Long term use.

Long-term use of glucocorticoids is controversial because of the increased risk of serious side effects (such as bone loss, mood changes [depression and anxiety] or exacerbation of diabetes), as well as a decrease in the effectiveness of symptom control over time.

The test results form for small doses of glucocorticoids (e.g., prednisolone 7.5 mg per day) for up to 2 years showed that there were initial benefits in terms of reducing symptoms, some of which were maintained for 2 years. In addition, the progression of articular damage was reduced over a two-year period. It is unclear whether similar benefits can be achieved with long-term treatment at lower doses. However, some patients may benefit from treatment with a very low dose of glucocorticoids (prednisone 1–4 mg per day), lasting indefinitely, along with biological therapy.

Due to the risk of side effects with prolonged use, glucocorticoids are usually limited to short-term use. However, in some patients with severe rheumatoid arthritis, it may be necessary to continue treatment with glucocorticoids for a long time at low doses (less than 10 mg/day).

Risks associated with chronic, long-term steroid use

The main risks associated with the chronic use of steroid procedures (usually at doses of 10 mg per day or more) include osteoporosis and an increased risk of fractures, bleeding, diabetes, cataracts, infections and effects on mood, energy, digestion, and immune system function. The risk of these side effects appears to increase with increasing doses of glucocorticoids.

There are several precautions and warnings that you should be aware of if you are taking corticosteroid treatment.

Increased risk of infection.

Glucocorticoids can increase your chances of getting an infection and make existing infections more difficult to treat. If you develop an infection while taking a steroid, tell your doctor right away. When taking a steroid, you should avoid contact with anyone who has chickenpox or measles.  Diagnosis of rheumatology .

Heart and kidney problems.

Glucocorticoids for rheumatoid arthritis should be used with caution if you have heart or kidney problems. Including congestive heart failure, hypertension, or renal failure.

Diabetes.

Glucocorticoids can affect (i.e. increase) your blood sugar, which can be problematic, especially if you have diabetes. If you notice changes in sugar tests (blood or urine), talk with your doctor.

Pregnancy and care.

Glucocorticoids should be used only in pregnant women if the benefits outweigh the risks. Although adequate studies of glucocorticoids in pregnant women have not been conducted, animal studies have shown an increase in birth defects. Glucocorticoids do pass into the breast milk of women who are breast-feeding and may have a harmful effect on nursing infants. Therefore, you should talk with your doctor about whether you should feed your baby while taking steroid treatment.



Mood changes.

Glucocorticoids with rheumatoid arthritis can lead to mood changes, ranging in intensity from weak to extreme. If you have a history of mood changes or mood disorders including depression, anxiety, and bipolar disorder, you should tell your doctor before starting steroid treatment. And you should keep track of mood changes while taking glucocorticoids.  Sleep with rheumatoid arthritis .


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