What are the implications of significant fluid overload and weight gain associated with long-term corticosteroid (steroid) treatments for Rheumatoid Arthritis (RA)?

From the Guidelines

Chronic steroid treatment for rheumatoid arthritis should be managed with the lowest effective dose to minimize significant fluid retention and weight gain, as recommended by the most recent guidelines 1. To manage fluid overload and weight gain associated with chronic steroid treatment, several strategies can be employed.

• Reducing sodium intake to less than 2 grams per day can help mitigate fluid retention.
• Limiting daily fluid intake to 1.5-2 liters may also be beneficial.
• Implementing a gentle exercise program focusing on low-impact activities like swimming or walking can help manage weight gain. Consider discussing with your rheumatologist about transitioning to steroid-sparing agents such as methotrexate, hydroxychloroquine, or biologics like adalimumab or etanercept, as these may have a more favorable side effect profile compared to long-term steroid use 1. Diuretics such as furosemide (20-40mg daily) or spironolactone (25-50mg daily) may be prescribed temporarily to reduce fluid overload, but these should only be used under medical supervision 1. Regular monitoring of weight, blood pressure, and electrolytes is essential while on steroid therapy, as steroids can cause fluid retention by increasing sodium reabsorption in the kidneys and altering the body's natural hormone balance, particularly affecting aldosterone pathways. Weight gain from steroids also occurs due to increased appetite and metabolic changes, so maintaining a balanced diet rich in potassium (found in fruits and vegetables) while limiting processed foods can help counteract these effects. It is crucial to weigh the benefits and risks of steroid treatment, considering the potential for cardiovascular events associated with long-term use of higher doses of glucocorticoids, as observed in observational studies 1. By prioritizing the lowest effective steroid dose and implementing lifestyle modifications, patients with rheumatoid arthritis can minimize the risks associated with chronic steroid treatment while maintaining optimal disease management.

From the FDA Drug Label

In particular, the increased risk of diabetes mellitus, fluid retention and hypertension in elderly patients treated with corticosteroids should be considered.

• The FDA drug label mentions fluid retention as a potential risk in elderly patients treated with corticosteroids, which can be associated with weight gain.
• This suggests that significant fluid overload and weight gain can occur with chronic steroid treatments, such as prednisone, especially in elderly patients 2.

From the Research

Significant Fluid Overload and Weight Gain with Chronic Steroid Treatments for Rheumatoid Arthritis

• There is no direct evidence in the provided studies that discusses significant fluid overload and weight gain with chronic steroid treatments for rheumatoid arthritis.
• However, the use of corticosteroids, such as prednisone, in combination with disease-modifying antirheumatic drugs (DMARDs) like methotrexate, is a common treatment approach for rheumatoid arthritis 3.
• The studies focus on the treatment guidelines and options for rheumatoid arthritis, including the use of DMARDs, biologic DMARDs, and targeted synthetic DMARDs 4, 5, 6, 7.
• While the studies discuss the efficacy and safety of various treatments, they do not specifically address the issue of fluid overload and weight gain associated with chronic steroid use.
• It is essential to consider the potential side effects of corticosteroids, including fluid retention and weight gain, when treating patients with rheumatoid arthritis, although this specific topic is not addressed in the provided studies.