Corticosteroids were first prescribed in the 1940s for patients with RA when Dr. Phillip Hench introduced cortisone to the world.
It was immediately hailed as a “miracle drug” and the cure for RA. High-dose cortisone was so potent and dramatically effective in the
treatment of RA that Hench and his colleague Kendall received the Nobel Prize in 1950 for their work.
It soon became apparent, however, that this powerful medication caused some serious side effects, particularly at the very high doses
being prescribed at that time. Because of this, most physicians in the 1960s and 1970s tried to avoid prescribing any corticosteroids.
Corticosteroids continue to produce side effects, but physicians have become more cautious in prescribing the medication. Physicians
generally follow these guidelines for use of corticosteroids. They are to be used
• by people whose arthritis cannot be controlled adequately by non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying
anti-rheumatic drugs (DMARDs) or by people who cannot take NSAIDs or DMARDs because of unacceptable side effects;
• in the smallest dose possible which allows the person to function (the medication should be taken in the morning as a single dose);
and
• for the shortest time possible.
If the dose and duration of corticosteroid use can be limited, the number of side effects can be diminished significantly. Treatment of some
of the rare and severe complications of RA does involve taking larger doses of corticosteroids.
It is common practice for doctors to prescribe low-dose corticosteroids on a temporary basis. If NSAIDs prove ineffective
(or cause intolerable side effects), corticosteroids can be substituted temporarily to control inflammation rapidly while awaiting
the effects of the slower-acting DMARDs. This is called bridge therapy. After the inflammation is controlled, corticosteroids need
to be tapered off slowly under a physician’s guidance. One should never abruptly discontinue corticosteroids without the supervision of a doctor.
A note of caution is in order here: do not let the relief provided by corticosteroids lull you into a false sense of security which causes
you to think about trying to avoid treatment with second-line drugs. Corticosteroids are extremely potent anti-inflammatory drugs, but they
may not halt the disease process.
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ARTHRITIS