Corticosteroids and NSAIDs are commonly used to treat rheumatoid arthritis (RA). Corticosteroids such as prednisone and methylprednisolone reduce inflammation and pain in RA by suppressing the immune system. They can cause side effects like hyperglycemia, osteoporosis, and adrenal insufficiency with long term use. NSAIDs like ibuprofen, naproxen, and diclofenac work by inhibiting cyclooxygenase and reducing prostaglandin synthesis to decrease swelling and pain. Celecoxib primarily inhibits COX-2. NSAIDs may cause stomach problems, high blood pressure, fluid retention, and rashes.

1. USE OF
CORTICOSTEROIDS AND NSAIDS IN RA
MONA YADAV
GROUP 3

2. CORTICOSTEROIDS
• Corticosteroids are also called steroids.
These drugs can help reduce inflammation
in RA. They may also help reduce the pain
and damage caused by inflammation.

3. CORTICOSTEROIDS
• glucocorticoids :-
• A) hormones :- hydrocortisone ( cortisol)
• B) synthetic :-
• Prednisolone
• Prednisone
• Methylprednisolone
• Dexamethasone
• Betamethasone
• Triamcinolone

4. CORTICOSTEROIDS
• 1 ) Prednisone :- is an immunosuppressant for the treatment of
autoimmune disorders; it may decrease inflammation by reversing
increased capillary permeability and suppressing
polymorphonuclear leukocyte activity. Prednisone stabilizes
lysosomal membranes and suppresses lymphocytes and antibody
production.
• dose :- Immediate-release: ≤10 mg/day PO added (DMARDs)
• Delayed-release: 5 mg/day PO initially, maintenance: lowest
dosage that maintains clinical response; may be taken at bedtime
to decrease morning stiffness with rheumatoid arthritis

5. CORTICOSTEROIDS
• 2) Methylprednisolone :- decreases inflammation by suppressing
the migration of polymorphonuclear leukocytes (PMNs) and
reversing increased capillary permeability.
• dose :- 40 mg/day PO divided q6-24hr.
• 3) SIDE EFFECT OF CORTICOSTEROIDS:-
• Hyperglycemia - due to increased gluconeogenesis
• Steroid-induced osteoporosis: reduced bone density
• Adrenal insufficiency (if used for long time and stopped suddenly)

6. NON- STEROIDAL ANTI- INFLAMMATORY DRUGS
NSAIDs are the most commonly used RA drugs.
• NSAIDs interfere with prostaglandin synthesis through
inhibition of the enzyme cyclooxygenase (COX), thus
reducing swelling and pain.
• TYPES :-
• a) acetic acid derivatives
• b) Carboxylic acid derivatives
• c) Proprionic acid derivatives

7. NSAIDS
• drugs :- Ibuprofen
• Naproxen
• Diclofenac
• Ketoprofen
• Celecoxib
• Aspirin
• 1 ) Ibuprofen is indicated for patients with mild to moderate
pain. It inhibits inflammatory reactions and pain by decreasing
prostaglandin synthesis.
• dose - 400mg po q6-8hr , not exceed 3000 mg/day

8. NSAIDS
• 2) Naproxen :- This agent inhibits inflammatory reactions and
pain by decreasing the activity of cyclooxygenase, which is
responsible for prostaglandin synthesis.
• dose - 500-1000 mg/day PO divided q12hr; may increase to
1500 mg/day if tolerated well for limited time.
• 3) Diclofenac :- is one of a series of phenylacetic acids that
have demonstrated anti-inflammatory and analgesic
properties. It is inhibit COX, which is essential in the
biosynthesis of prostaglandins.
• Diclofenac can cause hepatotoxicity; therefore, liver enzymes

9. NSAIDS
• dose :- Diclofenac sodium: 50 mg PO q8hr or 75 mg PO
q12hr.
• 4) Celecoxib is approved for the relief of signs and symptoms
of RA. It primarily inhibits COX-2, which is considered an
inducible isoenzyme (induced during pain and inflammatory
stimuli). Inhibition of COX-1 may contribute to NSAID
gastrointestinal (GI) toxicity. Administer the lowest possible
dose for each patient. Use of celecoxib has been associated
with an increased risk of cardiovascular toxicity.
• dose - 100-200 mg PO q12hr

10. NSAIDS
• side effect of nsaids: -
• Stomach problems like bleeding, ulcer and stomach upset
• High blood pressure
• Fluid retention (causing swelling, such as around the
lower legs, feet, ankles and hands)
• Rashes.