Last updated:19th April 2016

Corticosteroids (steroids)

Steroids have a powerful effect on inflammation.

Steroids are naturally occurring chemicals that help to make the body work. They are also used as medicines.

There are many different types of steroid, for example there are those used by weightlifters and body builders, but usually when we talk about treatment for arthritis we mean corticosteroids. Steroids can be prescribed in the form of local injections or tablets.

Local steroid injections

If you have an inflamed or swollen joint, or if you have pain or inflammation near a joint, your doctor may inject a steroid preparation into the affected area. It is known as a local injection because it acts only in that area.

There are two types of local steroid injection:

  • Injecting into a joint is called an intra-articular injection.
  • Injecting near a joint but not actually into it is called a peri-articular injection (meaning near the joint) or soft tissue injection.

Usually local steroid injections are given by a rheumatologist or rheumatology nurse but sometimes GPs can give them. They will choose the steroid preparation which they believe is best suited to your needs.

It is often recommended that a weight-bearing joint should be rested as much as possible for the first 1-2 days after an intra-articular injection. If this isn't possible, you should at least avoid strenuous exercise for the first couple of days.

If you are having physiotherapy, the physiotherapist may be keen to give more intensive treatment after the injection, while the joint is less painful.

The short-acting soluble steroids give relief within hours and should last for at least a week. The longer-acting, less soluble, steroids may take a few days to become effective but may give benefit for 2 months or longer. Injections can also temporarily imprve some of your other joints, particularly those close to the injection site.

There is general agreement that if an injection is very helpful, and other treatments are either inappropriate or less effective, the injection may be repeated every 3 to 4 months.

Side-effects are very unlikely but occasionally people notice a flare in their joint pain within the first 24 hours after an injection.This usually settles on its own within a couple of days.

Steroid tablets

Prednisolone is the most commonly prescribed steroid tablet for people with AS.

Prednisolone is available either as a plain tablet or in a special form, called enteric-coated, which is specially coated so that it does not dissolve quickly in the stomach. Your doctor may prescribe enteric-coated prednisolone if you have indigestion or you are taking a high dose.

It works very quickly. Usually you will notice a benefit within a few days

Steroids can be prescribed by your GP or by your rheumatologist or rheumatology nurse.

Your doctor will advise you about the correct dose. The dose will depend on why prednisolone is being used, and on your body weight. Often your doctor will start you on a high dose and then reduce this as your symptoms improve. If you have been on steroids for a long time, your doctor will make any reductions very slowly. Your doctor may decide that you should continue on a small dose (a maintenance dose) of prednisolone indefinitely. You should not stop taking your steroid tablets or alter the dose unless advised by your doctor. It can be dangerous to stop steroids suddenly.

The longer you take prednisolone, and the higher the dose, the more likely you are to have problems. Your doctor will take this into account and will keep you on the lowest possible dose that keeps your disease under control.

The most common side-effects are:

  • weight gain and/or increase in appetite
  • a round face
  • thinning of the bones (osteoporosis)
  • easy bruising
  • indigestion
  • stomach pains
  • stretch marks
  • thinning of the skin
  • muscle weakness and cataracts can occur, and prednisolone can also make glaucoma worse.

Any treatment with steroids may cause changes in mood - either elation or depression. This may be more common in people with a previous history of mood disturbance.

The blood sugar may rise, causing diabetes, and if you have diabetes you may require a change in the treatment of your diabetes. High doses of prednisolone can also cause a rise in blood pressure.

Taking prednisolone can make you more likely to develop infections. If this happens or if you have a fever you should tell your doctor. Signs of infection can be disguised by prednisolone. So if you feel unwell or develop any new symptoms after starting prednisolone, it is important to tell your doctor or rheumatology nurse.

You should see your doctor immediately if you have not had chickenpox and you come into contact with someone who has chickenpox or shingles OR you develop chickenpox or shingles. Chickenpox and shingles can be severe in people on steroid treatment. Therefore you may need antiviral treatment, which your doctor will be able to prescribe

Treatment with steroid tablets can cause osteoporosis, making fractures more likely. To reduce the risk it is a good idea to take regular exercise, make sure your calcium intake is adequate, and avoid smoking and excess alcohol. You should also ask your GP or hospital specialist for advice on your particular case. Your doctor may advise the use of drugs which have been shown to prevent bone loss due to steroids, for instance calcium and vitamin D supplements and bisphosphonates.

While you are on prednisolone it is best to drink only small amounts of alcohol or avoid it altogether. Do discuss this with your GP or rheumatologist.


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