COVID-19 advice for people taking steroids

23 June 2020 – updated information about dexamethasone

Steroids are an important treatment for people with conditions such as arthritis, vasculitis and joint pain. They’re usually taken as tablets or injections into muscles, joints or soft tissues.

Guidance about taking steroids

  • If you are already taking steroid tablets you should carry on taking them, unless your doctor tells you otherwise.

  • If you've been taking steroid tablets for four weeks or more, and you develop symptoms of COVID-19 talk to your GP or rheumatology team as soon as possible about your medication. They may tell you to stop taking some drugs, but the latest advice is that steroids should be continued if you have COVID-19. However, the dose you take and when during the day you need to take your tablets may need to be changed slightly. It’s important you talk to your doctor about this.

  • If you’re not currently taking steroids and you develop joint pain and swelling, your doctor should only start steroid tablets or give you a steroid injection if there are no other options for your condition. And in which case your doctor should give you the lowest possible dose of steroids for the shortest possible time.

It can be dangerous to suddenly stop taking steroids, as they can cause withdrawal symptoms. If you are taking steroid tablets you should carry a steroid alert card. It is important for a healthcare professional to know if you are on steroids and the dose you are taking, in case you suddenly become ill or have an accident.

Where has this information come from?

This information was developed by NHS England and is referred to in the NICE (National Institute of Health and Care Excellence) rapid guidelines for managing rheumatological autoimmune, inflammatory and metabolic bone disorders during the coronavirus outbreak.

Dexamethasone and COVID-19

It’s been announced that the common arthritis drug, dexamethasone, can help save the lives of people who are seriously ill with COVID-19.

Dexamethasone is a type of corticosteroid, which is commonly used to reduce inflammation in people with inflammatory arthritis or autoimmune conditions like rheumatoid arthritis, lupus and gout.

Research into using this drug to treat coronavirus was conducted as part of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial by the University of Oxford to test a range of potential treatments for COVID-19.

Due to the immune-suppressing properties of dexamethasone, researchers decided to test its effectiveness in treating coronavirus patients with severe respiratory symptoms.

Researchers found that dexamethasone reduced deaths by one-third in ventilated patients, and by one fifth in other patients receiving oxygen only. There was no benefit among those patients who did not require respiratory support.

Dexamethasone is a readily accessible drug, and the first that’s shown to improve survival rates in COVID-19.

While it is effective for treating coronavirus patients requiring respiratory support for severe respiratory symptoms, guidelines should still be followed for people taking the drug to treat inflammatory or autoimmune conditions.