Glucocorticoids (GCs)

Glucocorticoids are naturally produced by the adrenal glands which sit atop each kidney. The adrenals support the body in times of stress. They calm inflammation in the body.  Unfortunately, during the inflammation caused by RA,  the adrenals do not produce enough glucocorticoids to suppress the inflammation.  Synthetic GCs provide relief because they are like the body’s natural supply of cortisol.

Glucocorticoids were first administered in 1948 by Philip Showalter Hench to treat RA. Over the years the glucocorticoids have become refined and have become lifesaving in RA as well as in many other diseases such as Lupus and asthma.

The following are common glucocorticoid preparations: prednisone (Deltasone, Medicorten, Orasone), methylprednisolone (Medrol), Betamethasone (Celestone), Solu-medrol.

• Prednisone is used initially with a DMARD such as methotrexate at disease onset to relieve symptoms of RA until the DMARD become effective. This is known as bridge therapy.  Noted in the Annals of Internal Medicine 2012: a study has shown that adding prednisone to methotrexate early on combine to produce less joint damage, less physical disability, and reduced disease activity.

• Dr. John R. Kirwan, of the University of Bristol Academic Rheumatology Unit suggests that prednisone along with another DMARD should be considered the gold stand of early treatment.⁴⁷

• Prednisone or methylprednisolone is also used during a flare to relieve symptoms. A Medrol dose pack may be ordered. A Medrol dose pack is a regimen of Medrol given at specific times over six days. Low dose prednisone may be given at 5-10 mg daily until symptoms subside. And then the prednisone is tapered downward.

• Medrol is useful for maintaining disease control during pregnancy when most DMARDs are contraindicated.

• Glucocorticoids are used for intra-articular injections where one or two joints are involved. GCs are administered in high doses IV for treating organ-threatening disease caused by RA.

• Prednisone or Medrol may be used  on a regular basis for patients with severe disease not managed by DMARDs. Low dose therapy is under 10 mg a day for prednisone and 8 mg for Medrol. Medrol 4 mg=Prednisone 5 mg

Oral  prednisone should not be stopped abruptly. It should be stopped gradually to avoid withdrawal side effects. Frequently, calcium and vitamin D supplements are encouraged.

Long term, high dose use of these drugs can contribute to the development of osteoporosis  and spinal fractures. Side effects are serious but are not worse than the side effects of many of the DMARDs.

Excerpt from My Rheumatoid Arthritis Handbook to be released late summer 2022.