Corticosteroids in the Management of Rheumatoid Arthritis

Introduction

Corticosteroids are predominantly used for symptomatic relief of acute pain and inflammation associated with RA (Singh et al., 2015). Their anti-inflammatory effects are more potent than NSAIDs; however, they have a less desirable side effect profile. Consequently, they are utilized when NSAIDs are not adequately managing acute symptoms (Singh et al., 2015).

Mechanism of Action

Corticosteroids modulate gene expression by binding to glucocorticoid receptors (McKay, 2003). Specifically, they promote the up-regulation of anti-inflammatory genes and down-regulation of pro-inflammatory genes (McKay, 2003). This inhibits the inflammatory effects of circulating monocytes and eosinophils, thus contributing to relief of acute symptoms (McKay, 2003).

Clinical Implications

Common adverse effects of corticosteroids include immunosuppression, steroid-induced diabetes and osteoporosis, muscle weakness, thin skin, easy bruising, hypertension, edema, and hypokalemia (Bingham, 2017). Several of these side effects are of particular note for the PT. Immunosuppression may lead to increased incidence of infection; the PT should follow proper infection control protocol between patients including sanitation of all surfaces and hands. Osteoporosis is a contraindication for several PT 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 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.