Rheumatoid Arthritis

Steroid tablets, injections & intravenous pulses

Steroids (full name corticosteroids) are very effective in reducing inflammation and so are often prescribed for people with rheumatoid arthritis (RA) (see Arthritis Research UK). They can be taken in four main forms'

  • daily tablets
  • by injection into individual joints
  • in a solution given intravenously as a drip over 1-2 hours (often called a 'pulse')
  • by injection into a muscle (thigh or buttocks)

People are often prescribed a steroid in one form or another to overcome the initial symptoms of RA and/or while other medication eg disease modifying anti-rheumatic drugs (DMARDs) take effect. Higher doses can also be prescribed for short periods to help people overcome a 'flare' of their RA.

Steroid tablets (Prednisolone)

Several people we talked to were taking or had taken a steroid daily and this ranged from a few months to 42 years. People described the effects of steroids as decreasing pain, increasing mobility, making them feel more 'lively', but some were unsure of their effect.

Steroid tablets used to be prescribed more readily before the problems of long-term, higher dosage use were well known. People who were taking them regularly had often reduced the dosage, over time, to a minimum to still keep their symptoms at a bearable level but described the difficulties in safely reducing the dose. One woman's doctor was 'happy for her to control her steroid tablets within limits' during a flare.

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A woman who had side effects from DMARDs found steroids the only medication that would work. Several people said they were worried about the unwanted effects and would prefer not to take them; one woman chose to stop taking steroids (over time) in favour of taking more painkillers. However one woman felt that the improved quality of life it gave her was worth the risks.

People mentioned a number of short-term side effects, including nausea/vomiting, headaches, mood swings and flatulence. Longer term effects known to occur include weight gain and puffiness, particularly of the face, which one woman described. Skin becomes thin and delicate and is then easily injured or bruised. Steroids also reduce bone density leading in time to osteoporosis. Bone density scanning (See 'Regular monitoring and other diagnostic tests') can identify those at risk and some people took a calcium supplement or had increased the amount of calcium in their diet to improve their bone density. In children and teenagers high doses of steroid can interfere with growth.

One woman felt that after taking steroids for about 8 years she couldn't make decisions effectively and felt her head was a 'fug' and 'as if there's a blanket wrapped round your brain and you had to fight to get anything out of it', but when she stopped taking them she could again make quick decisions.

Steroid Joint injections

Hydrocortisone can be injected directly into particularly painful or inflamed joints ('in flare'). People we talked to had received injections into different joints, most commonly the knee but all of the following were mentioned' hips; ankles; toes; shoulders; elbows; wrists; fingers and the jaw. Several people found these injections painful or very painful and decided not to have any more. Fluid may be drawn out ('aspirated') from the joint via a needle immediately before a steroid injection to help improve the symptoms.

Different people described the effect of the injections as 'brilliant', 'helpful', reducing the pain for a while, 'calms down the joint' and 'not a lot'. However, one woman's hands were worse after injections into her fingers. In some the joint injection solved the problem and the pain disappeared, in others the effects lasted from 2-3 weeks to approximately two months or more when some had repeat injections.

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Doctors may use imaging equipment to help them to inject the steroid into the correct point, eg. into the hip. One man had pins and needles after a wrist injection and one woman who had her jaw injected said the anaesthetic had paralysed her face for some hours after the injection.

Injections are sometimes available at short notice via the Rheumatology clinic and some people could phone and have one later that week.

Steroid Pulses (methyl-prednisolone intravenous drips)

Many people had received a steroid pulse at times when their symptoms were worse. The steroid solution is infused over 1-2 hours via a cannula inserted into a hand or arm vein. This usually involves a 2-3 hour hospital visit but some people had had 2 or 3 such pulses over 2-3 days.

The effects are often immediate with people describing them as a 'miracle', immediately feeling better, lots of relief, reduced pain, increased mobility, more energy, 'doing the world of good' and 'putting the spring back in their step'. However, the effects may last only a short time - 2-3 days or weeks or months. People also said they didn't feel the same effects every time they had a pulse - the first ones had more effect than later ones. People reported being on a 'high' for a few days - one person had sleepless nights, others did as much as they could whilst they had the energy. Other short-term effects were feeling faint, 'wobbly' in the morning and overheating; a rare side effect suspected in one woman was deep vein thrombosis.

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Depo-Medrone (slow-release methylprednisolone) injections

Depo-Medrone injections into muscle are similar in effect to 'pulses'. For a few people this was the main medication every few weeks or months. However, most people described them as a 'back-up' or 'safety net' that they would have only 3-4 times a year. One woman felt they worked better than the steroid pulses.

For more information on steroids see Arthritis Research UK

Last reviewed August 2010.

Last updated September 2010.

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