Corticosteroids in the Management of Rheumatoid Arthritis

Original Editor - Amanda Kerser Top Contributors - Amanda Kersey, Rucha Gadgil, Kristie Nguyen and Temitope Olowoyeye  

Introduction[edit | edit source]

Corticosteroids are predominantly used for symptomatic relief of acute pain and inflammation associated with rheumatoid arthritis.[1] Their anti-inflammatory effects are more potent than those of non-steroidal anti-inflammatory drugs (NSAIDs); however, they have a less desirable side effect profile. Consequently, they are utilised when NSAIDs are no longer adequately managing acute symptoms.[1]

Mechanism of Action[edit | edit source]

Corticosteroids modulate gene expression by binding to glucocorticoid receptors. Specifically, they promote the up-regulation of anti-inflammatory genes and the down-regulation of pro-inflammatory genes. This inhibits the inflammatory effects of circulating monocytes and eosinophils, thus contributing to relief of acute symptoms.[2]

The half life of corticosteroids ranges from less than 20 minutes to up to 120 minutes for large steroid loads. Elimination rates vary greatly, ranging from 15-200 mg per day.[2]

Common Adverse Effects[edit | edit source]

Common adverse effects of corticosteroids include immunosuppression, steroid-induced diabetes and osteoporosis, muscle weakness, thin skin, easy bruising, hypertension, edoema, and hypokalemia.[3]

Clinical Implications[edit | edit source]

Several of these side effects are of particular note for the physical therapist (PT).

  • Immunosuppression may lead to an increased incidence of infection; the PT should follow proper infection control protocols between patients, including sanitation of all surfaces and hands.
  • Osteoporosis is a contraindication for several physical therapy interventions, so PTs must proceed with caution when selecting treatments and modalities. Reference this page for physical therapy management of osteoporosis.
  • If signs of developing osteoporosis or diabetes are noted, the PT should notify the patient's primary care physician.
  • Due to easy bruising and thin skin, PTs should ensure that they are monitoring the skin integrity of the patient at each session.
  • When assessing muscle strength, be aware that weakness may be due to corticosteroid treatment.
  • PTs should be taking vitals every session in order to monitor for hypertension secondary to corticosteroid use.

References[edit | edit source]

  1. 1.0 1.1 Singh JA, Saag KG, Bridges Jr SL, Akl EA, Bannuru RR, Sullivan MC, Vaysbrot E, McNaughton C, Osani M, Shmerling RH, Curtis JR. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis & rheumatology. 2016 Jan;68(1):1-26.
  2. 2.0 2.1 Banyal A, Tiwari S, Sharma A, Chanana I, Patel SK, Kulshrestha S, Kumar P. Vinca alkaloids as a potential cancer therapeutics: recent update and future challenges. 3 Biotech. 2023 Jun;13(6):1-7.
  3. Bingham, C. John Hopkins University. Rheumatoid arthritis treatment. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/. Accessed October 3, 2018.
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