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March 2011
No Bones About Steroids
Side Effects of Steroids in Rheumatoid Arthritis
Rheumatoid arthritis is a chronic condition that causes inflammation (swelling, heat) in the joints.This inflammation, if left untreated, can damage the joints to the point a person can’t walk or take care of himself. Currently, several medications are available and rheumatoid arthritis can be treated and controlled.

Steroids are molecules normally produced in the body and serve various functions. Here are the facts of the case, before we go into the details:
  • The glucocorticoid hormone produced by the body is available as tablets and is frequently referred as “steroids”.
  • Glucocorticoids effectively and quickly reduce allergies and inflammation (swelling and redness associated with tissue injury) and hence are used in skin allergies, asthma and arthritis.
  • Several glucocorticoids are available under names like Prednisolone, Methylprednisolone and Dexamethasone.
What Do Steroids Do?
Steroids are used in rheumatoid arthritis during the initial phase when the inflammation is extensive or if the patient has vasculitis (inflammation of a blood vessel), kidney disease or eye inflammation. As steroids quickly reduce inflammation, they are used until the slow acting drugs such as Methotrexate and Sulphasalazine start working. They are also used intermittently if patients have severe flare-ups of the disease.

Side Effects of Joint Injections
Steroids injected into the joint act locally and effectively reduce inflammation.There is a small risk of infecting the joint and whitening of the skin at point of entry. Repeated injection may weaken the tendons and can cause tendon rupture. Overall occasional injection of the joint with steroids is safe and can be used until medications start working.

Short Course Side Effects
Short courses are usually safe. Mood disturbances, lack of sleep, weight gain and worsening of peptic ulcer (stomach ulcer) if the patient is also taking painkillers, are some of the side effects observed.

6 Side Effects of Prolonged Usage
Prolonged use of low dose steroids(less than 7.5 mgs a day) is associated with several side effects and is dose dependent.

Osteoporosis: Weakening of the bone to the point the person is more prone for fractures. The Rheumatoid arthritis by itself is a risk factor for osteoporosis (thin bone) and addition of steroids can make this worse.

Weight gain: Patients tend to gain weight around the abdomen with weakening of the muscles of the arms and legs.

Diabetes: Taking steroids increases the risk of diabetes.

Atherosclerosis: The risk for thickening of the blood vessels with cholesterol plaques (atherosclerosis) is increased.

Risk of infection: Steroids increases the risk of skin infection and lung infection. Fungal infection of the mouth is common.

Cataract: Early cataract is common with the regular use of steroids.

7 Side Effects of High Dosage
Moderate (7.5-30mgs) to high doses (more than 30mgs a day) of steroids cause these side effects – in addition to those mentioned above:

Muscle weakness:A person can develop weakness in sitting and getting up.

Bone death: A portion of the bone may die from lack of blood supply (osteonecrosis) causing severe pain in the bone.

Hypertension: The blood pressure may increase.

Skin changes: Thinning of the skin and easy bruising is observed.

Peptic ulcer: in the stomach - especially if the patient is also taking painkillers - and sometimes even perforation of the stomach wall has been observed.

Mood and behavioural changes: Lack of sleep, irritability, psychosis (altered perception) are common.

Electrolyte imbalance: Low potassium, calcium and fluid retention can occur. It has to be said that taking steroids do not cause kidney damage.

3 Tips to Prevent Side Effects
  1. Adequate intake of calcium and vitamin D as well as certain drugs called Bisphosphonates reduce risk of osteoporosis.
  2. Acidity reducing tablets reduce risk of peptic ulcer
  3. Steroids should be taken in the morning or on alternate days

5 Precautions
  1. Always consult the physician before changing doses or stopping steroid.
    These drugs should never be stopped suddenly.
  2. Consult your doctor if you develop fever or infection.
  3. Periodically check your blood pressure,sugar and cholesterol.
  4. Avoid smoking.
  5. Eat healthy and exercise as recommended.
  Dr. Shrilekha is Consultant - Rheumatology at Apollo First Med Hospitals, Chennai

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