Steroid Injections

[pip12]

I saw my Rheumy last week and she confirmed I am having a flare at the moment. She still would like me to go on Methotrexate or Sulphasalazine. I have refused them in the past and still don't want to take them. She said I could have steroid injections, 3 in total a fortnight apart, but she said that steroid injections could make things a lot worse. I agreed to have the injections and had the first last Wednesday and must admit it has made me feel a lot better. I do realise that this could only be temporary and eventually it will come back. Just wondering if anybody else has been told that steroid injections can make RD a lot worse or if she is just miffed cause I won't have Methotrexate

[nomoreheels]

I think it would be very unprofessional of her, particularly if your reasons for choosing not to have methotrexate were valid ones, but I could understand her position if she was concerned about a patient under her care with uncontrolled & unmedicated RD preferring to have repeated steroid injections. I'm a firm believer that a judicious approach should be taken with steroid injections. In the main, they're only considered as a short term option at the start of treatment to cover the period between starting DMARDs & them having effect or when flaring (ie not controlled by meds) as they can, if injected long term, cause very real damage. If continually injected into the same joints they may weaken the ligaments & tendons, even causing the tendon to rupture. They can accelerate loss of cartilage, cause skin thinning & loss of the fat layer beneath the skin & if repeated around the same joint (3-4 times a year) can cause osteoporosis or even osteocrosis in post menopausal women. They can become less effective over time & of course in the meantime the RD is progressing if not taking appropriate meds causing deformity & the risk of heart attack/stroke.

I'm sorry if all this sounds all doom & gloom but I'm a great believer in if there's a medication suggested that could give me half a chance of lessening the chance being disfigured like my nan then I will consider my Rheumy's advice, talk through any concerns I may have & make my decision or choice based on his knowledge of the meds & his experience of their success.

Methotrexate has been the one which has given me good results for 5 years now having first tried hydroxychloroquine, again good results but became less effective. Nevertheless I've never had steroid injections before being given one for trigger finger last July, the only alternative in my case as if it worsens after the hydrocortisone wears off an op may be my only option. I do take low dose steroids after them being continued as part of my OA treatment but prescribed a weekly bisphosphonate & Adcal-D3 daily to preserve bone density.

Would it be helpful do you think if you spoke about your concerns to your Rheumy? Maybe she could allay your fears of DMARDs or suggest an alternative to the more common ones to help reduce inflammation & likely damage or at least try to moderate the progression.

I hope this helps & doesn't sound too one sided, but I've tried to be as truthful as possible in answering with my experience of seeing people with awful consequences of too many steroid injections over prolonged periods.

[02tkwillx]

Hi

I had a flare up two weeks ago so I begged my GP for steroids whilst waiting for my consultant to get back to me with an emergency app. They did make me feel a bit better but really they just mask the arthritis, but it did reduce the inflammation in my elbow- it was so bad I couldn't even use my arm, I also had It in my jaw, collar bone & back (all new places) I am now going to start MTX on Saturday I have refused them up to now. Anyway back to steroids ... My consultant told me I must wean myself off them as I'm on 30mg each day for 10 days now. He said they are extremely bad for your body especially tablet form like I'm taking. Injection is milder. I've had steroids injections in my feet when they swelled up and they haven't swelled up since. I really hope they work for you for a long time. X

[pip12 in reply to 02tkwillx]

Thank for the replies guys. I have had steroid injections before in my fingers, wrists and shoulder but it was a while ago. These I am having now are injected in your bottom, but upto now (I've only had one) it has definitely helped, shoulder, back, hands and legs. She just got to me the way she said they could make it far worse, never heard anybody say steroid injections had made them worse. xx

[nomoreheels in reply to pip12]

I would ask her just what she meant, there's no point second guessing. Continually having steroid injections will complicate an already complicated disease. She's followed NHS guidelines & offered you more expensive DMARDs & because you've refused them you still have active uncontrolled RD & you're asking her to just treat inflammation which will will allow the disease to progress. I suppose put bluntly you're not being a perfect patient refusing to take her advice & it's going against her instinct & training as a Rheumatologist. She wishes to treat with the appropriate meds to protect further damage & joint deformity, cardiovascular health & other comorbidities that come with active RD if left untreated.