How Steroids Are Used in the Treatment of Psoriatic Arthritis

If you live with psoriatic arthritis (PsA) , you know how painful and disruptive a flare can be: Stiff, swollen joints and inflamed skin can make even simple tasks feel impossible. That’s often when steroids enter the picture. The potent anti-inflammatory drugs are one of the quickest and most accessible tools doctors have to bring that inflammation under control. Whether taken by mouth, injected into a joint, or applied directly to the skin, steroids can also be used to buy time until other long-term treatments kick in. While there’s no doubt that steroids are very effective in treating PsA symptoms in the short term, doctors are careful about how and when to use them due to potentially harmful side effects that add up with long-term use. “Steroids are powerful rescue tools in psoriatic arthritis. They work fast, but because of serious side effects and rebound flares, we use the lowest dose for the shortest time possible,” says Elaine Husni, MD , vice chair of rheumatic and immunologic diseases at Cleveland Clinic in Ohio. Keep reading to better understand the different types of steroids used for PsA, how they work, what risks they carry, and their role as part of a safe and effective treatment plan.
Oral (Systemic) Steroids Oral Steroids In psoriatic arthritis, oral steroids are used to control acute joint inflammation. Typically, systemic steroids work faster and may be administered to the patients at the beginning of the diagnosis to control inflammation sooner, especially in the patient who has more severe joint inflammation in multiple joints, says Rupak Thapa, MD , assistant professor of medicine at Wake Forest University and rheumatologist and internal medicine doctor at Atrium Wake Forest Baptist in Winston-Salem, North Carolina. In that scenario, it’s likely that disease-modifying antirheumatic drugs (DMARDs) or biologics would be prescribed, says Dr. Thapa. But while those drugs are highly effective, they can take up to three months to control PsA.e60dc2a1-f33c-4a05-9b50-8e3e8e59762905296988-da96-4b87-a3ac-6fea7b7e5539 In those situations, oral steroids, while not part of the long-term strategy, would be prescribed as a “bridge therapy” to manage symptoms until the disease-modifying treatments take effect, says Dr. Husni. At that point, the steroids would be tapered off. Oral steroids may also be used in patients who flare intermittently despite DMARDs treatment, says Thapa. “However, if this is happening frequently, adjustment or modification of DMARDs is recommended to avoid the side effects of systemic steroids.” Pros and Cons of Oral Steroids “The main benefit is their fast action. Patients often feel better within hours to days, which can be life-changing during a severe flare,” says Husni. However, the downsides are significant, she adds. Short-term side effects of oral steroids include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762932704f22-e969-4336-994e-dae592f924fd Insomnia Mood swings Fluid retention Increased appetite Spikes in blood sugar Spikes in blood pressure Long-term side effects include: Osteoporosis Diabetes Hypertension Cardiovascular disease Eye problems like cataracts and glaucoma Skin thinning Increased infection risk “Another major issue is the ‘rebound effect’: When steroids are stopped, symptoms can return, sometimes worse than before,” says Husni.
Steroid Injections Injections “A steroid injection allows us to target the inflammation locally without exposing the whole body to systemic steroid effects,” says Husni. “Steroid injections are typically only used in PsA when only one or two joints are inflamed. Injecting multiple joints at the same time isn’t recommended; in those scenarios systemic steroids are favored,” says Thapa. If there’s any doubt why a joint is inflamed — for example, an infection — a steroid injection is typically avoided until the joint fluid is aspirated and analyzed, he says. “The benefit of a steroid injection is it has more local action in the joint, has less systemic absorption, and less risk of systemic side effects compared to oral steroids,” says Thapa. The pain relief that a steroid injection provides can vary from person to person, but typically lasts between a few weeks and a couple months, says Husni. It’s recommended that you don’t get more than three injections in the same joint in one year, says Jonathan Greer, MD , rheumatologist at Arthritis & Rheumatology Associates of Palm Beach in Florida. “Additionally, it’s recommended that you wait at least three months before you would get a steroid injection in the same joint,” he says. That’s because repeated injections may soften cartilage and cause the joint to break down faster, and it can delay healing if there’s any issue with healing elsewhere in the body, says Dr. Greer. Other side effects include temporary pain flare at the injection site, risk of infection, and skin thinning or color change at the injection site, says Husni.
Topical Steroids Topical Steroids Topical steroids are mostly for psoriasis skin lesions, not joints, says Husni. Many people with psoriatic arthritis also have psoriasis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629211ad0d1-e7d3-4118-8082-07c40dddc5ae “These can help treat the skin manifestations of psoriatic disease by reducing redness, itching, and scaling in psoriasis lesions,” she says. Typically, topical steroids are used for about two weeks and in certain situations can be used for up to four weeks, depending on the site and size of the rash, and the formulation and strength of the medication, says Thapa. The more potent the steroid, the more effective it is at clearing psoriasis, but the side effect risk goes up. Low-strength steroids are typically used for sensitive areas like the face, groin, and breasts.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298b338c4a-b5ca-4e57-9700-8fde4f26deb3 The benefits of topical steroids are that there’s less systemic absorption and less risk of systemic side effects, especially if they’re used for a shorter duration and smaller lesions, he says. Potential side effects of topical steroids include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976298b338c4a-b5ca-4e57-9700-8fde4f26deb3 Skin thinning Changes in pigmentation Easy bruising Stretch marks Redness Dilated surface blood vessels
Talking to Your Doctor About Steroids Talking to Your Doctor Some people have “steroid-phobia,” and are reluctant to use them, even in the short term. “Patients often worry about side effects — weight gain, mood changes, or long-term risks like bone loss. Some fear becoming ‘dependent’ on steroids, while others are anxious about the rebound effect when stopping,” says Husni. Husni validates those concerns: There are real risks involved with steroids. “That’s why we aim for the lowest dose for the shortest duration possible. I emphasize that steroids are a ‘rescue’ therapy, not a maintenance strategy, and that we have safer long-term medications to control PsA,” she says. Some patients have the opposite concern: They’ve felt much better after a round of steroid treatment and wonder if the doctor is limiting access unnecessarily. Those concerns are also understandable, says Husni. “That experience is valid — steroids do work fast, and the relief is real. But I explain that the hidden risks accumulate over time and can outweigh the benefits,” she says. Ultimately, these are decisions that each patient needs to make with their medical provider, says Husni. “Each patient is different and may need more personalized recommendations on steroid therapy.”
The Takeaway Steroids can provide fast relief from joint pain, stiffness, and skin symptoms in psoriatic arthritis. Oral steroids and injections are usually used along with DMARDs or biologics as a “bridge” or short-term “rescue” treatment. Because long-term or high-dose steroid use can cause serious side effects, experts recommend the lowest effective dose for the shortest possible time. Talk with your doctor about whether steroids are right for your situation, and how they fit into a long-term treatment plan that includes safer, steroid-sparing therapies.