What are steroids?
A syringe and an assortment of steroid pills; photo by iStock
Steroids (short for corticosteroids) are synthetic drugs that closely resemble cortisol, a hormone that your body produces naturally. Steroids work by decreasing inflammation and reducing the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions.
Corticosteroids are different from anabolic steroids, which some athletes use to build bigger muscles. Examples of corticosteroid medications include triamcinolone, cortisone, prednisone, and methylprednisolone.
How Many Types of Arthritis Are There?
There are many types of arthritis (over 100 identified). The types of arthritis range from those related to wear and tear of cartilage (such as osteoarthritis) to those associated with inflammation resulting from a misdirected immune system (such as rheumatoid arthritis). While osteoarthritis and rheumatoid arthritis are common types of arthritis, there are many other common and uncommon types of arthritis.
Other types of inflammatory arthritis include;
- psoriatic arthritis,
- ankylosing spondylitis, and
- reactive arthritis.
Types of infectious arthritis include septic arthritis and Lyme arthritis.
Together, the many types of arthritis make up the most common chronic illness in
the United States. Self-limited forms of arthritis can occur in association with
How do steroids work?
Steroids decrease inflammation and reduce the activity of the immune system. Inflammation is a process by which the body's white blood cells and chemicals protect the body against infection and foreign organisms such as bacteria and viruses.
In certain diseases, however, the body's defense system (immune system) doesn't function properly and is overactive. This may cause inflammation to work against the body's own tissues and cause tissue damage. Inflammation is characterized by redness, warmth, swelling and pain.
Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells.
What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis
Do steroids work?
When inflammation threatens to damage critical body organs, steroids can be organ saving and, in many instances, life-saving. For example, they may help prevent the progression of kidney inflammation, which can lead to kidney failure in people who have lupus or vasculitis. For these people, steroid therapy may eliminate the need for kidney dialysis or transplant.
Low doses of steroids may provide significant relief from pain and stiffness for people with conditions including rheumatoid arthritis. Temporary use of higher doses of steroids may help a person recover from a severe flare-up of arthritis.
What are steroid injections used for?
Steroids often are injected directly into joints to treat conditions such as rheumatoid arthritis, gout, or other inflammatory diseases. They also can be injected into an inflamed bursa or around tendons near most joints in the body.
Some people report relief from osteoarthritis when steroids are injected directly into swollen or painful joints.
The term arthritis refers to stiffness in the joints.
Why are steroids injected?
Injecting steroids into one or two areas of inflammation allows doctors to deliver a high dose of the drug directly to the problem area. When doctors give steroids by mouth or IV, they cannot be sure an adequate amount will eventually reach the problem area. In addition, the risk of side effects is much higher with oral or IV steroids.
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What are the benefits of steroid injections?
Steroid injections into a specific area are generally well tolerated and are less likely than other forms of steroid drugs to produce serious side effects. Also, the injections may help avoid the need for oral steroids or increased doses of oral steroids, which could have greater side effects.
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How are steroids administered? What forms of steroids are available?
- Steroids can be given topically (cream or ointment), by mouth (orally), or by injection.
- Steroids injection can be given into a vein or muscle, directly into a joint or bursa (lubricating sac between certain tendons and the bones beneath them) or around tendons and other soft tissue areas.
- Steroid shot can offer fast-acting relief of inflamed muscles, joints, tendons, and bursa.
What are steroids used to treat?
Steroids are used to treat a variety of conditions in which the body's defense system malfunctions and causes tissue damage. Steroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle). They may also be used selectively to treat inflammatory conditions such as rheumatoid arthritis, lupus, Sjögren's syndrome, or gout.
What are the side effects of steroid injections?
Steroid injections are one of the most effective ways to decrease pain and improve function, yet they generally do not cure the illness.
In rare instances, the following side effects might occur:
- Allergic reactions
- Bleeding into the joint
- Rupture of a tendon
- Skin discoloration
- Weakening of bone, ligaments, and tendons (from frequent, repeated injections into the same area)
Not everyone will develop side effects and side effects vary from person to person. If steroid injections are infrequent (less than every three to four months), it is possible that none of the listed side effects will occur.
What are the side effects of oral steroids?
Side effects are more common with a higher dose and longer treatment. Side effects are much more common with oral drugs. Some side effects are more serious than others. Common side effects of oral steroids include:
- Blurred vision
- Cataracts or glaucoma
- Easy bruising
- Difficulty sleeping
- High blood pressure
- Increased appetite, weight gain
- Increased growth of body hair
- Lower resistance to infection
- Muscle weakness
- Nervousness, restlessness
- Stomach irritation or bleeding
- Sudden mood swings
- Swollen, puffy face
- Water retention, swelling
- Worsening of diabetes
Please note: The side effects listed are the most common side effects. All possible side effects are not included. Always contact your doctor if you have questions about your personal situation.
How can steroid side effects be minimized?
To minimize the side effects of steroids, doctors follow these guidelines:
- Use steroids only when necessary.
- Monitor closely to detect the development of serious side effects.
- If possible, use steroid injections for problems in a specific area.
- Use the minimal dose required to gain control of the disease.
- Reduce the dose gradually if the disease remains under control.
- Monitor blood pressure often and treat if necessary.
- Recommend calcium supplements, vitamin D, and bone-building prescription medications to help maintain bone strength (this is done especially if steroids will be taken for a long period of time).
- Have your bone density checked every one to two years.
Does everyone develop side effects of steroids?
No. How often any side effect occurs varies from person to person. If steroid use is brief (from a few days to a few weeks), it is possible that none of the listed side effects will occur. The side effects listed generally do not occur when occasional steroid injections are given for arthritis, tendinitis, or bursitis.
However, if steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects may occur.
What role do steroid injections play in an overall treatment program?
Steroid injections can be added to a treatment program that may already include anti-inflammatory pain medications (NSAIDs), physical therapy, occupational therapy, or supportive devices such as canes and braces. Whether one or more of these treatment methods are used depends on the nature of the problem.
For example, in an otherwise healthy person, tendinitis may be adequately treated with only a steroid injection into the inflamed area. However, in a person with rheumatoid arthritis, injections are generally a small part of a multifaceted treatment approach.
When should steroid injections not be used?
Steroids should not be injected when there is infection in the area to be targeted or even elsewhere in the body because they could inhibit the natural infection-fighting immune response. Also, if a joint is already severely destroyed, injections are not likely to provide any benefit.
If someone has a potential bleeding problem or is taking anticoagulants (often referred to as blood thinners), steroid injections may cause bleeding at the site. For these people, injections are given with caution.
Frequent steroid injections, more often than every three or four months, are not recommended because of an increased risk of weakening tissues in the treated area.
Who should not take steroids?
Steroids, as with other drugs, are not recommended for everyone. In general, people with the following conditions should not take steroids:
How do you know if steroid treatment is right for you?
The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, your overall health, and other drugs you are taking. Your doctor also will make sure you understand the potential benefits and risks of steroids before you start taking them.
Agency for Healthcare Research and Quality: "Rheumatoid Arthritis Medicines: A Guide for Adults."
UpToDate for Patients: "Patient Information: Rheumatoid Arthritis Treatment."
The Johns Hopkins Arthritis Center: "Rheumatoid Arthritis Treatment."
AGS Foundation for Health in Aging: "Arthritis Pain."
Medline Plus: "Cushing Syndrome."