Glucocorticoids (hereafter referred to as “hormones”) are one of the drugs used to treat rheumatoid arthritis, but you cannot rely on hormones to treat rheumatoid arthritis. Many patients with rheumatoid arthritis use hormones inappropriately at the beginning of treatment, resulting in long-term hormone dependence and suffering from hormone side effects. Hormones have become the “opium of rheumatoid arthritis”. 1. Relying on hormone therapy for rheumatoid arthritis is a mistake Hormone therapy for rheumatoid arthritis has a history of half a century, and it is one of the most controversial drugs in the treatment of rheumatoid arthritis. In 1949, a 26-year-old female patient with rheumatoid arthritis who had been bedridden for three years received hormone therapy from a British doctor and was able to miraculously relieve her pain and get up and walk. This was the first case of rheumatoid arthritis treated with hormones, and it was a world-wide sensation, and the medical community thought that a cure for rheumatoid arthritis had been found. However, in the early 1950s, British doctors organized a series of clinical studies and determined that hormones were not a good treatment for rheumatoid arthritis. The reason is that after a patient receives hormone therapy, it is very difficult to reduce and stop the drug, and the more hormones are used, the more long-term hormone therapy has more side effects than the disease itself. In other words, hormones can accelerate the development of disability and even lead to death, and in 1953, British doctors already published an article in an important international medical journal warning against the abuse of hormones in the treatment of rheumatoid arthritis. Because of their very strong anti-inflammatory and pain-relieving effects on rheumatoid arthritis, hormones are very attractive to both doctors and patients. Some patients take hormones to relieve their pain; some doctors inject hormones into patients to show that they can “cure the disease”; some clinics mix hormones into their homemade “proprietary medicines” to show their “secret recipes”. Some clinics, in order to show their “ancestral recipe” special effects, mix hormones in their homemade “Chinese patent medicine”; there are also many patients in Hong Kong and Macao to buy “anti-rheumatic special tablets” (in fact, they are “hormones + painkillers + vitamins”). And so on, resulting in patients rely on hormones, can not be separated from hormones, rheumatoid arthritis “addict”. 2, clever use of hormones to treat rheumatoid arthritis Relying on hormones to treat rheumatoid arthritis is a mistake, but in the comprehensive treatment of rheumatoid arthritis, clever addition of small doses of hormones, not only to improve the efficacy, but also to avoid side effects. In the 1990s, the international view on the treatment of rheumatoid arthritis was to advocate the addition of small doses of hormones at the beginning of treatment, i.e., no more than 2 tablets of prednisone per day, and the course of treatment should not exceed 3 months as far as possible. Into this century, according to the latest research view in the United States, for refractory rheumatoid arthritis, hormone treatment can be extended, but the dose of hormone cannot be increased. Therefore, when treating rheumatoid arthritis with hormones, there are 2 principles: firstly, you should not take more than 2 tablets per day; secondly, you should only take hormones in the early stage of treatment, or in refractory patients who do not recover. If your rheumatoid arthritis is being treated with hormones and you leave these 2 principles, it is necessary to consider changing your doctor and seek treatment from another rheumatologist. Treatment with inappropriate use of hormones not only fails to achieve therapeutic effect, but is also dangerous treatment. 3, scientific withdrawal of hormones does not need to increase the pain If rheumatoid arthritis patients are unfortunately “addicted to hormones”, they need to try to “quit” it. Many patients tell me, “I know that hormones have a lot of side effects, but I can’t help it, I don’t care about the side effects when I’m in pain. In fact, scientific withdrawal of hormones does not need to increase the pain of arthritis. In the treatment of rheumatic diseases, there is a class of drugs called “hormone reducers”. The safest and most effective hormone reducer is methotrexate. Since the mid-1990s, rheumatologists across the United States have advocated methotrexate as the drug of choice for the treatment of rheumatoid arthritis. Today, it would be a shame if patients with rheumatoid arthritis did not use, or could not use, methotrexate. This is because rheumatoid arthritis nowadays will have a decidedly different outcome with and without methotrexate. There is no second drug internationally that can match the efficacy of methotrexate in the treatment of rheumatoid arthritis. And methotrexate is very inexpensive. Injections cost only a few dollars per week, and oral methotrexate costs just over $1 per week. Of course, methotrexate is an anti-cancer drug with potential toxicity and needs to be administered under the guidance of a specialist, not blindly on your own. As long as it is used correctly, the side effects of methotrexate are much lower than those of hormones. For elderly rheumatoid arthritis patients after menopause, Chinese medicinal preparations such as Lei Gong Tang, Torch Flower Root Tablets and Kunming Shan Hai Tang are also safe and effective “hormone helpers”. However, young patients should not use these herbal preparations for a long time because they have high gonadal toxicity and can cause ovarian damage and menopause in young women in their twenties and thirties. Slow withdrawal of hormones along with the use of hormone helper reducers, to the end of withdrawal of hormones, can be done without increasing the pain of arthritis. Of course, rheumatoid arthritis should be treated under the supervision of a rheumatologist to be safe and effective, and to withdraw from hormones without increasing pain.