Taken by mouth (pill form, oral)
How It Works
Corticosteroids are similar to natural
hormone substances produced by the body that help to reduce
Why It Is Used
Corticosteroids are often used to
treat juvenile idiopathic arthritis. Corticosteroids that are taken by mouth or
injected are most often used to control the initial stages of systemic
juvenile idiopathic arthritis (JIA). Corticosteroids may also be used in
children who have
polyarticular disease with severe morning stiffness or
A short "burst" therapy (initially high doses of
oral corticosteroids that are tapered off) may be useful
when inflammation around the heart (pericarditis) or fever is present in
Corticosteroids may also be
used as "bridge" therapy when starting a stronger second-line medicine, such
as methotrexate, to control symptoms while the new medicine takes effect.
After a period of time, the corticosteroid is slowly withdrawn to see whether
the other medicine is effective.
Injections of corticosteroids may be used to treat specific
joints when conservative therapy has controlled symptoms well except in those
are used in children who develop inflammatory eye disease.
How Well It Works
Corticosteroids can provide rapid,
dramatic improvement in some people with JIA.1
- Oral corticosteroids are often useful:
- For children with systemic JIA who have
fever and inflammation of the protective sac around the heart
- For controlling night pain or morning stiffness in
- For controlling a flare-up of symptoms in polyarticular
- While waiting for another drug such as methotrexate or
etanercept to take effect. Methotrexate and etanercept are disease-modifying
antirheumatic drugs (DMARDs).
- Injected corticosteroids usually help when they
are injected into the painful joints of children who have limited arthritis,
especially in children who have not responded to nonsteroidal anti-inflammatory
drugs (NSAIDs) or who can't tolerate NSAIDs.
corticosteroids can help manage joint disease. But they are usually used only
in children who have life-threatening complications such as pericarditis.
- Corticosteroid eyedrops usually act quickly to control a flare-up
of eye inflammation.
Side effects of high or long-term
corticosteroid doses in children include:
- Growth suppression.
- Bone thinning
- Moon-face appearance with fluid retention and weight gain
(cushingoid appearance, related to
- Mood swings.
Long-term use of corticosteroids causes significant side
effects, including a weakened
immune system and weakened muscles.
can help reduce side effects, including growth problems, by giving your child
this medicine in the morning rather than at night. A low dose at bedtime is
sometimes used to treat severe morning stiffness.1
See Drug Reference for a full list of side
effects. (Drug Reference is not available in all systems.)
What To Think About
Long-term use of corticosteroids
is not advisable due to the significant side effects. Low-dose corticosteroids
have fewer side effects and may be appropriate for longer use in difficult
In some cases the dose of corticosteroids that controls
symptoms is too high for long-term use. The best dose may be a balance between
a higher dose that controls symptoms well but causes significant side effects
and a lower dose that doesn't control all symptoms completely but causes fewer
If your child is given corticosteroid treatment for
2 weeks or more, the medicine should be gradually reduced (tapered) rather
than abruptly stopped. Tapering helps the body adjust to the change. But some children have a temporary increase in pain when corticosteroid treatment
After a corticosteroid joint injection, your child
should use the joint as little as possible for a day or two. A cast or splint
may be put on the joint of a young child to protect the joint from excess
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Giannini EH, Brunner HI (2005). Treatment of juvenile
rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp.
1301–1318. Philadelphia: Lippincott Williams and Wilkins.
Primary Medical Reviewer
||Susan C. Kim, MD - Pediatrics
Specialist Medical Reviewer
||John Pope, MD - Pediatrics
Current as of
||June 5, 2012