Steroids: how they're used in rheumatology
A plain-language guide to the steroids used in rheumatology: what they are, the different ways they are given, what to expect, and why they are not the same as the steroids misused in sport
Steroids are among the most effective and widely used treatments in rheumatology, yet they are also among the most misunderstood. The word often brings to mind the anabolic steroids misused by some athletes, but the steroids used in rheumatology are a completely different kind of medicine. This guide explains what they are, the different ways they can be given, what they are used for, and their side effects, so that any treatment can be discussed with the facts in view.
Written for patients and reviewed by Dr Liubov Borukhson, Consultant Rheumatologist (GMC 7021928). Last clinically reviewed: June 2026.
What are steroids (corticosteroids)?
The steroids used in rheumatology are corticosteroids, a man-made version of cortisol, a hormone the body produces naturally to control inflammation. They work by calming inflammation and quietening an overactive immune response, which is why they are so useful across rheumatology. Common examples include prednisolone, methylprednisolone and triamcinolone.
They are not the same as anabolic steroids, the muscle-building drugs sometimes misused in sport. Anabolic steroids are based on testosterone and act in an entirely different way, for an entirely different purpose. Corticosteroids do not build muscle, and they do not carry the effects associated with anabolic steroid misuse. This is a common and understandable source of worry, so it is worth being clear about from the outset.
The different forms
Corticosteroids can be given in several ways, and the choice depends on what is being treated:
- As tablets, such as prednisolone, taken by mouth. These act on the whole body and are used when a more general effect is needed.
- As a local injection into or around a single joint, tendon sheath or bursa, where the medicine acts mainly where it is placed. This is covered in our guides to steroid injections: when they help and ultrasound-guided injections.
- As a systemic injection, when a whole-body effect is wanted: either into a muscle (an intramuscular injection), or, for severe or organ-threatening disease, a higher dose given into a vein as a short course, sometimes called a steroid pulse.
So a steroid injection is not always a local treatment; it depends on where and why it is given. Which form is most suitable is always decided with you, based on the diagnosis.
What they are used for
In rheumatology, steroids are used to bring inflammation under control quickly. Typical uses include settling a flare, giving relief while a slower-acting disease-modifying medicine takes effect, and treating conditions that respond especially well to steroids, such as polymyalgia rheumatica and giant cell arteritis. Higher-dose systemic steroids, including intravenous pulses, have an important role in severe, active disease such as some forms of vasculitis and lupus, while a local injection is used when a single joint or soft-tissue problem needs settling. Steroids control inflammation rather than curing the underlying condition, so they are usually part of a wider plan.
Side effects, and how they are kept low
Side effects depend heavily on the dose and how long a steroid is taken. A single local injection usually causes few problems, and any effects are mild and short-lived. The side effects people associate with steroids come mainly from higher doses taken over longer periods, whether as tablets or systemic courses, and can include effects on blood sugar and blood pressure, weight gain, mood changes, a higher risk of infection, and thinning of the bones over time. For this reason steroids are used at the lowest effective dose for the shortest sensible time, with monitoring, and longer courses usually include bone protection. Importantly, these are the effects of a corticosteroid, and are quite different from the harms linked to anabolic steroid misuse.
Using steroids safely
A few simple points make steroid treatment safer. If you have taken steroid tablets for more than a short time, the dose must be reduced gradually and never stopped suddenly, because the body needs time to resume making its own cortisol. You may be given a steroid card, or advised to carry one, so that other healthcare professionals know you are taking steroids, which matters particularly if you become unwell. As with any treatment, the plan is agreed with you and kept under review.
Common questions
Are these the same as the steroids some athletes use?
No. The steroids used in rheumatology are corticosteroids, which calm inflammation and are a man-made version of a hormone the body makes naturally. They are a completely different type of medicine from the anabolic steroids sometimes misused in sport to build muscle, with a different purpose and different effects.
Will a steroid injection affect my whole body?
A local injection into a joint, tendon sheath or bursa acts mainly where it is placed, with little reaching the rest of the body, so any side effects are usually mild and short-lived. Steroids can also be given into a muscle or a vein when a deliberate whole-body effect is needed, which is a different, systemic use.
Do steroids always cause weight gain and other side effects?
No. Side effects come mainly with higher doses taken over longer periods. A single local injection rarely causes them. Where a longer course is needed, it is kept to the lowest effective dose, monitored, and usually paired with bone protection to keep the risks as low as possible.
Can I stop steroid tablets suddenly?
No. If you have taken steroid tablets for more than a short time, the dose needs to be reduced gradually rather than stopped abruptly, because your body needs time to readjust. Your team will guide the reduction, and it is sensible to carry a steroid card.
Why might I be offered a steroid into a muscle or a vein rather than into a joint?
Because the aim is sometimes a whole-body effect rather than treating one area, for example an injection into a muscle to settle a widespread flare, or an intravenous pulse of steroid for severe, active disease. The route is chosen to match what needs treating.
Questions about steroid treatment?
A specialist assessment can explain whether a steroid is right for you, which form would suit, and how any risks are kept low
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