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Should I have a second steroid injection?

I was diagnosed with RA 5 weeks ago rf negative but anti ccp positive at 471. I have been picked up early thanks to my knowledge as a physio and quick referral using my health insurance. My consultant is lovely but I still have so many questions. The steroid really helped my feet and hands although my 4th mcp (knuckle) has remained swollen and a little sore. I think as symptoms have just started to come back he will offer me another steroid as per the NICE guidelines. However can I be too good to have it? I understand it is needed to keep me in remission while the MTX kicks in, and I don't want to risk joint damage or a return of symptoms to before I was diagnosed but I can cope with the symptoms. It sounds like so many people have much more severe pain than me. It is certainly interesting being on the other side of the fence! I have so many questions and I am learning so much despite having treated people with RA before! Any thoughts great fully received. S

8 Replies


I was diagnosed in Febuary this year. I was given a steroid injection at my first appointment and it did help. Ive been taking MTX 10mg a week which has just been increased to 15mg.

I had a second steroid injection a few weeks ago because my hands were still very tender and swollen. I chose not to have third one last week as im a little afraid of the side effects further on in my life. Every one is different and I suppose it depends on your personal circumstances.

Good Luck

Trish. x


As Trish says, everyone is different with different circumstances/medical history. But to me the steroids are not just about feeling better but also makes it easier for the MTX to do it's stuff as the inflammation is damped down. I'm not sure this is hugely scientific as an explanation, but if your body is packed full of out of control inflammation then it's got a big hurdle to climb before being able to make a real difference. Imagine the difference between looking after one unruly child or a whole classroom full.... And the difference between 2 or 3 steroid jabs is probably not going to make any difference in terms of long terms effects. So for me I'd take all the help I can to start with as gives a better chance of getting controlled quickly and getting your life back. Polly


Thanks for the quick responses! I go to see him Thursday so will let you know outcome. S


I didn't have any steroids while waiting for the MTX to work. I wasn't offered any and didn't want them either. Instead I relied on Ibuprofen taken at regular intervals to keep my inflammation down (with stomach protectors). This suited me better because it gave me more control and having tried a steroid injection and a course of Prednisolone in the run up to diagnosis I found that both made me bipolar. This wasn't a factor for my rheumy because he wasn't told I don't think - but he preferred me to rely on NSAIDs until MTX did its thing as steroids have other implications re bone thinning so should be saved for rainy days I think. But I agree with Polly that its important to get the inflammation down to help the MTX to work. NSAIDs can do that too - and physio really helped me too! Tilda x


Hi Lukaduka,

I was diagnosed in September last year, I have been given steroid injections on a regular basis until we can find a drug that will stop my RA in its tracks( may be there but that is a separate issue) . Steroids were given IM in December and January, followed by IV February and April. I understand your concerns about the tolls this drug takes however short term I am prepared to do that. The bolus doses of steroids really did help to the point where I felt normal again, for a period of time.

Each of us is individual and reacts differently to treatment, so, as a nurse of 20 years, I would say, if your rheumatology team are recommending it, you take it. It really does not matter what anyone else is dealing with, and I know that there are so many worse than me.

Professionals are always the worst patients

I do hope your day is manageable and you are pacing yourself

Gentle hugs

Katie x



I was diadnosed privately with an anti CCP positive of 1100. I wasn't offered steroid injections but orally, 20mg Pred p/d one week, stepping down 5mg p/w while the MTX kicked in, I was up to 12.5mg Meth after week four and the seroids stopped. Like you I felt the symptoms were manageable. Phychologically it was more important to me to start the MTX to begin the process of slowing it down, that in itself made me more relaxed and eased the symptoms. At the end of the day it's what you feel comfportable with

Good luck



Thanks so much for everyone's comments it makes me feel supported even if there is no right or wrong answer! I saw my gp today for my first blood test after taking MTX for two weeks and she thinks they will still offer it as she can still see inflammation in the one knuckle! She did however say she would be happy to do it in a couple more weeks if I want to see how my symptoms are. S


Just an update, I had the steroid injection, as that is what my consultant recommended. He could feel activity in at least 4 joints and said it is not only for pain relief but also to prevent joint damage. With that in mind, and because I rely on my hands so much for my job, I took the jab and I feel I have made an informed decision. Long term he said the side effects are minimal as it is such a short time period on steroids. Thanks for all your advice, it really does help, even though ultimately everyone has to make their own mind up what is best. S


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