The first thing one must discuss when the topic of steroids and RA comes up is that there is a big difference between anabolic and corticosteroids. The former are associated with muscle mass gain popularized by illegal use in athletes. The later are connected with metabolism and immunity. Now that we’ve cleared up that little issue, we can delve into the use of steroids in the treatment of RA.
Corticosteroids are powerful anti-inflammatory medicines and they are regularly used for all sorts of inflammatory problems. The most common forms of administration in RA patients are joint site injections and oral pills. But this effectiveness of fighting inflammation comes with side effects. The most common side effects of corticosteroid use include the following:
Elevated pressure in the eyes (glaucoma)
Fluid retention, causing swelling in your lower legs
Increased blood pressure
Weight gain, with fat deposits in your abdomen, face and the back of your neck
High blood sugar, which can trigger or worsen diabetes
Increased risk of infections
Loss of calcium from bones, which can lead to osteoporosis and fractures
Suppressed adrenal gland hormone production
Thin skin, easy bruising and slower wound healing [i]
Other side effects I would like to add to this list are difficulty sleeping and redness of the skin. For joint injections, patients will often overuse the joint because it feels so good resulting in further damage to tissue. There are probably other side effects and I hope readers chime in with their stories. This long list of side effects is why I categorize steroids as the Nuclear Weapon against RA. While they do an excellent job of fighting the enemies of RA-inflammation-they impact the entire body.
Most RA patients have experienced the famous Medrol Dose Pack. This handy package starts with 6 pills the first day and ends with one pill on day six. The first time I was prescribed Medrol was a weekend when I had a terrible reaction to methotrextate. My doctor pulled me off methotrexate and immediately put me on a dose pack in an effort knock down the RA symptoms until I could get into his office to begin Enbrel. The dose pack really helped me feel better until Enbrel started working. But because of the side effects, I try to avoid them as much as possible.
This was not my first experience with corticosteroids. Five years ago, before even being formally diagnosed with RA, a major case of iritis (inflammation of the eye) hit both eyes. It finally took a visit to an Ophthalmologist to figure out what was happening. He immediately prescribed regular doses of prednisone eye drops. They started out every two hours (all night long) and eventually tapered off over the next month. One interesting side note…this episode was the first sign of RA. The Ophthalmologist started asking me strange questions about joint problems and told me that iritis in both eyes simultaneously is an indicator of autoimmune disorders. No blood tests were run and I quickly forgot about it until other symptoms cropped up later.
Just like superpower countries, a stockpile of corticosteroids remains stashed away just in case things get out of hand and the inflammation enemy strikes with a vengeance. Currently though, there seems to be détente between the enemy and my body. Other medicines seem to be doing the trick. But my finger remains ready to push the button releasing a nuclear war if needed.