What are steroids?

Why are steroid tablets prescribed?

What are the possible side-effects?

What are the risks?

What else should I know about steroids?

What are steroids?

Some steroids occur naturally in the human body. Man-made steroids act like natural steroids to reduce inflammation. They can be given as injections or in tablet form. 

They can be extremely effective in both reducing inflammation and controlling the body’s response to inflammation. Prednisolone is the most commonly prescribed steroid tablet for people with rheumatic arthritis.

What do they do?

They reduce inflammation, and can therefore ease pain and stiffness caused by a number of conditions.

What are they used for?

They are used for rheumatoid arthritis, lupus (SLE), polymyalgia rheumatica (PMR) and other types of inflammatory arthritis. They are also sometimes used for severe osteoarthritis, and for gout.

How are they taken?

They can be taken in tablet form, or as an injection into a particular joint, tendon, or other area such as a bursa to control specific areas of inflammation.

Are there any side-effects?

Side-effects can include weight gain, osteoporosis, stomach pains and thinning of the skin. The risk of side-effects is related to the dose of steroid and the duration of the treatment, so your doctor will want to review your treatment from time to time to keep the risks to a minimum.

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Why are steroids prescribed?

Steroids can help with rheumatoid arthritis, lupus (SLE), polymyalgia rheumatica (PMR) and other types of inflammatory arthritis. They are very effective against inflammation. They will not cure your condition but will suppress your symptoms.

When and how do I take steroid tablets?

Prednisolone is usually taken once a day, preferably in the morning, with or after food. It is sometimes prescribed to be taken every other day. Enteric-coated tablets should be swallowed whole, not crushed or chewed.

Your doctor will advise you on the correct dose, which will depend on your condition and your weight. Your dose is likely to be reduced as your symptoms improve. If you have been on steroids for a long time, your doctor will make any reductions very slowly.

Your doctor may decide that you should continue on a small dose (a maintenance dose) for a long time.

You should not stop taking your steroid tablets or alter the dose unless advised by your doctor. It is dangerous to stop steroids suddenly if you have been taking them for more than two weeks.

How long do steroid tablets take to work?

Depending on the dose you take and the reason you are taking it, prednisolone can work very quickly. You may notice an improvement within a few days.

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What are the possible side-effects?

The longer you are taking prednisolone and the higher the dose, the more likely you are to have side-effects. Your doctor will take this into account and make sure you are on the lowest possible dose that keeps your condition under control.

Steroids are often necessary for treating your condition, so it is important to carefully weigh up the risks and benefits of continuing to take them. If you are on a very low dose you may never experience any problems.

The most common side-effects are:

• weight gain and/or increase in appetite
• thinning of the bones (osteoporosis)
• bruising easily
• indigestion
• a round face
• stretch marks
• thinning of the skin.

Prednisolone can also cause muscle weakness and cataracts, and it can make glaucoma worse. It may occasionally interfere with the menstrual cycle.

Any treatment with steroids may cause changes in mood – you may feel very high or very low. This may be more common in people with a previous history of mood disturbance. If you are worried please discuss this with your doctor.

Your blood sugar may rise, causing diabetes. If you already have diabetes you may need to discuss with your doctor whether you need to change your diabetes treatment.

High doses of prednisolone can cause your blood pressure to rise. If you suffer from epilepsy, it is possible that prednisolone could make it worse.

If your child is taking steroids, their growth may be suppressed. However, some of the conditions for which steroids are prescribed can also affect growth.

Taking prednisolone can make you more likely to develop infections. You should tell your doctor if you have a fever. Signs of infection can be disguised by prednisolone, so if you feel unwell or develop any new symptoms after starting prednisolone it is important to tell your doctor or rheumatology nurse.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

What should I look out for?

You should see your doctor immediately if:

• you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
• you develop chickenpox or shingles.

Chickenpox and shingles can be severe if you are on steroid treatment. You may need antiviral treatment, which your doctor will be able to prescribe.

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What are the risks?

It is important to keep an eye on your weight while you are on steroid treatment. If you find your appetite increases making sensible food choices and including some physical activity in your daily routine should help to avoid putting on weight. Keeping your steroid dose as low as possible can also help, so you should speak to your doctor if you are concerned about putting on weight.

How can I reduce the risk of osteoporosis?

Steroids can cause your bones to weaken, making fractures more likely. Your doctor may advise you to take drugs called bisphosphonates or calcium and vitamin D supplements along with the steroids to help prevent this. In general it is also a good idea to exercise regularly, make sure you get enough calcium in your diet and avoid smoking and drinking too much alcohol.

Will it affect vaccinations?

If you are taking steroid tablets it is recommended that you avoid live vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the vaccination with you.

If you are in your 70s and are offered shingles vaccination (Zostavax) you should seek advice from your rheumatology team – you may be able to have the shingles vaccine if you are on a low dose of steroids.

Pneumovax (which gives protection against the most common cause of pneumonia) and yearly flu vaccines do not interact with steroid tablets and it is important that you have these. 

Can I drink alcohol while on steroid tablets? 

Both alcohol and steroids can potentially upset the stomach. If you have indigestion or other stomach problems after starting steroid treatment then alcohol is likely to add to the problem, so you may want to cut back on how much alcohol you drink.

Do steroid tablets affect fertility or pregnancy?

There is no evidence to suggest that steroid doses used to manage your disease can affect your fertility. It is these medications that are usually prescribed at the lowest dose possible by your rheumatologist to manage active disease during your pregnancy.  If you are planning a family you should discuss this with your doctor beforehand, as it is important that the mother’s health is maintained during pregnancy. If you become pregnant while you are on steroids, do not stop them before discussing it with your doctor. Never stop steroids abruptly.

Does it affect breastfeeding?

Small amounts of steroid could pass into the breast milk. While it is unlikely to be harmful to your baby (and people do breastfeed while taking steroid tablets), you should discuss the risks with your doctor if you have any concerns.

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What else should I know about steroid tablets?

When taking steroid tablets you must carry a steroid card, which records how much prednisolone you are on and how long you have been taking it. If you become ill, or are involved in an accident in which you are injured or become unconscious, it is important for the steroid to be continued and also the dose might need to be increased. This is because the treatment may prevent your body from being able to produce enough natural steroids. Your doctor, rheumatology nurse or pharmacist can give you a steroid card. Make sure whoever is prescribing your tablets records any changes in dosage.

Are there any alternatives?

A number of other drugs are used in the treatment of inflammatory arthritis and other rheumatic conditions. Your doctor or rheumatology nurse will discuss these other options with you.

Will I need any special checks while on steroid tablets? 

Your doctor should check your weight, blood pressure and blood sugar level from time to time.

Can I take other medicines alongside steroid tablets?

Steroids may be prescribed along with other drugs. Some drugs interact with prednisolone, so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you’re taking prednisolone. Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

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