Corticosteroid Treatments for Rheumatoid Arthritis: What Black Americans Should Know
Using corticosteroids too much or too often could have health risks.
Corticosteroid treatment can play an important role in managing rheumatoid arthritis (RA). This class of medication usually can help relieve an acute flare from inflammatory arthritis quickly. This may help you get back in remission faster.
However, using corticosteroids too much or for too long may have negative health effects, so it is generally not recommended to make corticosteroids a mainstay of chronic treatment. Unfortunately, there may be some racial disparities in which populations tend to receive corticosteroids more often for the treatment of RA.
“There are studies showing that Black Americans [may be more likely to be] given corticosteroids instead of a biologic or DMARD as treatment for rheumatoid arthritis,” says Maggie Cadet, MD, Rheumatologist in New York City. (DMARD stands for disease-modifying antirheumatic drug.)
Why are corticosteroids not a good long-term treatment for RA?
Corticosteroids may reduce inflammation quickly, but they generally don’t treat the underlying disease progression over the long term. They’re typically safe for occasional use in the appropriate dose, but corticosteroids can come with health risks, especially when used chronically or too often.
Risks of long-term use of corticosteroids include:
Osteoporosis, bone loss, and fractures
Cataracts
Weight changes
Increased risk for infection
Stomach irritation or even a gastrointestinal bleed
Type 2 diabetes
High blood pressure (may also happen with acute use)
Mood changes (may also happen with acute use)
Why is there a racial disparity in corticosteroid use for rheumatoid arthritis?
Doctors may prescribe corticosteroids more often for Black Americans for a few reasons.
First, Black Americans may be less likely to have a primary care doctor and to seek treatment at an emergency department during a flare. These doctors may be less familiar with the individual’s overall health and treatment history.
Second, better treatments for RA may be costly and difficult for families to afford. Individuals may feel like they have to settle for over-the-counter pain relievers or may have challenges with insurance coverage of certain prescriptions (depending on their plan), which may require some navigation. These may be more affordable but may not be enough to treat more advanced RA.
Finally, systemic barriers to care may make it more difficult for Black Americans with RA to access specialized care and appropriate treatments, such as geographical access.
What are biologics for rheumatoid arthritis?
One treatment option for moderate-to-severe RA is biologic therapy. These are “medications that target specific chemicals that can cause inflammation in the body,” says Dr. Cadet. There are many types of biologics for RA that work in slightly different ways.
Biologics may help prevent disease progression, joint damage, and RA complications. They may also help prevent flares and reduce the need for corticosteroids.
Is it possible to save money on better treatments for rheumatoid arthritis?
Biologics may be costly, which may be a barrier for some families. This is a topic you can discuss with your doctor, who can refer you to programs, resources, and other professionals who may be able to help you access medications at a reduced cost.
Plus, undertreating your RA may lead to frequent visits to the emergency room for flare treatment. These visits usually cost more than visiting your primary care doctor or rheumatologist. Better management of your RA with the right medication (such as a biologic agent) may reduce unnecessary and costly emergency room visits.
“It is important to know that there are resources available out there to help Black Americans get access to trusted rheumatologists, as well as other primary care doctors that can help oversee their care,” says Dr. Cadet.
- Magdalena Cadet, MDMagdalena Cadet, MD, is a board-certified Rheumatologist in New York. She specializes in autoimmune diseases, arthritis, and health conditions that disproportionately affect women and minorities.
References
American College of Rheumatology. (2023). Glucocorticoid-induced osteoporosis.
American College of Rheumatology. (2021). Rheumatoid arthritis.
Arthritis Foundation. (n.d.). Corticosteroids.
He, E., et al. (2020). Characterization of racial disparities in rheumatoid arthritis treatment choice and location of care. American College of Rheumatology.
Moore, B. J., et al. (2020). Statistical brief #268: costs of emergency department visits in the United States, 2017. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet].
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2019). Rheumatoid arthritis.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2019). Rheumatoid arthritis: diagnosis, treatment, and steps to take.