Occasionally, the use of corticosteroids is necessary to gain rapid control of rheumatoid arthritis or other inflammatory rheumatic disease after early diagnosis or during a painful flare. However, to avoid or reduce side effects, the goal is to use oral corticosteroids on a short-term basis. Oral corticosteroids do not play a role in the treatment of osteoarthritis and fibromyalgia.

  In treating rheumatoid arthritis, oral corticosteroids, such as Prednisolone and Prednisone, work rapidly to control inflammation and pain. The possibility for serious side effects associated with long-term steroid use, however, does raise some concern. Studies have found that mortality rates in people taking long-term corticosteroids are twice that of other RA patients, although this may be due to the fact that people taking these medications generally have a more severe form of the disease. Your physician may inject corticosteroids directly into joints for relief of flare-ups when only one or a few joints are affected. Experts suggest no more than two or three injections a year.

Side Effects of Corticosteroids
  Undesirable side effects of long-term corticosteroids include weight gain, hypertension, susceptibility to infection, capillary fragility, acne, excess hair growth, cataracts, glaucoma, diabetes, wasting of the muscles, accelerated hardening of the arteries (atherosclerosis), menstrual irregularities, irritability, insomnia and psychosis. Steroids appear to cause premature death of bone-forming cells and slow their replacement; osteoporosis and bone damage are of particular concern because of the severe long-term side effects. 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. For bone loss, the American College of Rheumatology recommends that patients take 1,500 mg of calcium a day; vitamin D supplements may also be warranted. Medications that can prevent osteoporosis include parathyroid hormone, risedronate (Actonel), alendronate (Fosamax), or hormone replacement therapy in older women. It is important to know that long-term use of steroid medications suppresses secretion of natural steroid hormones by the adrenal glands. Slow withdrawal from these drugs is required because use of oral corticosteroids suppresses the ability of your own adrenal glands to produce natural steroids. Never simply stop taking a corticosteroid without the advice from your physician. It can take the body a while (sometimes up to a year) to regain its ability to produce natural steroids again. The risk increases during times of stress. Undergoing surgery is a form of physical stress that requires steroid monitoring and adjustment of your medication.

  If you have questions about the appropriate use of cortisone in the treatment of arthritis, do be sure to discuss your concerns with your primary care physician or rheumatologist.

About the author:
Jan Revella, R.N., Arthritis Nurse Specialist, is founder and director of Arthritis Education by Professionals, Inc., based in Phoenix, Arizona. She is among the most prominent speakers and educators on the subject of arthritis in the United States. Her mission is to empower people with arthritis to use knowledge as power when making decisions about their personal healthcare. Arthritis Education by Professionals, Inc. provides educational programs and services to people with arthritis.

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