Quick answer: Steroid tablets such as prednisolone damp down the immune system, so infections such as colds, flu, COVID-19 and chest infections are more likely. The NHS advises calling a doctor or NHS 111 straight away if you get signs of infection, such as a high temperature or shivering, a cough, a very sore throat or pain when you pee, and telling your doctor straight away if you have been near someone with chickenpox, shingles or measles. Never stop steroid tablets suddenly, and show your steroid emergency card if you have one.
Many people with rheumatoid arthritis take steroid tablets for a while — to calm a flare, or while a slower medicine such as methotrexate starts working. This guide is about one job: spotting infection early when you or someone you care for is on steroids, especially if they are older or living with frailty, and knowing who to call. For how steroids are used in arthritis more generally, see our steroids for arthritis guide.
Why steroids raise infection risk
Steroids work partly by damping down the immune system, which is why they calm the inflammation in rheumatoid arthritis. The same effect makes it easier to catch infections and can make them more serious. The NHS says the chance of side effects is higher with higher doses and when you take steroids for longer. Risk can add up if you also take other medicines that affect the immune system, such as DMARDs, biologics or JAK inhibitors, and if you are older or living with frailty.
Signs of infection to act on
The NHS advises calling a doctor or NHS 111 straight away if you take prednisolone and get:
- a high temperature, or you feel hot, cold or shivery
- a very sore throat, or ear or sinus pain
- a cough, or a change in the colour of your saliva or phlegm
- pain when you pee
- mouth sores, or a wound that will not heal
In older people, infection does not always cause a fever. Sudden confusion, a fall, going "off their legs", or not eating and drinking can be the first signs. Carers should trust their instincts and ask for advice early.
When it is an emergency
Call 999 or go to A&E if someone on steroids:
- is breathing very fast or struggling to breathe
- is confused, has slurred speech or is not making sense
- has blue, pale or blotchy skin, lips or tongue
- has a rash that does not fade when you press it
- has a very high or very low temperature, or uncontrollable shivering
These can be signs of sepsis. Take the person's medicines, or a list, and their steroid emergency card if they have one. A joint that becomes hot, red and very swollen, especially with fever, also needs urgent advice — a joint infection is an emergency.
Chickenpox, shingles and measles
The NHS advises keeping away from people with an infectious illness while you take prednisolone, especially measles, chickenpox or shingles. If you have been in contact with someone who has one of these, tell your doctor straight away — they may be able to give you a medicine to protect you.
Never stop steroids suddenly
- Do not stop, skip or change the dose of steroid tablets yourself, even when you feel unwell or worry about infection. If you have taken them for more than a few weeks, stopping suddenly can be dangerous and your arthritis may flare
- When you are ill, your body may need more steroid, not less. Ask your doctor or pharmacist what to do on sick days, and write it down
- If you have been on prednisolone for more than 3 weeks or on a high dose, you will usually be given a blue steroid treatment card. Your doctor or pharmacist may also advise you to carry a red steroid emergency card — show it to anyone treating you, including dentists and paramedics
- If you are being sick and cannot keep your tablets down, get urgent advice from your GP or NHS 111
Vaccines and everyday protection
- Tell the nurse or pharmacist you take steroids before any vaccination. Live vaccines are not usually suitable, but non-live vaccines such as the injected flu jab and the non-live shingles vaccine are, according to the NHS
- Our flu jab guide and vaccines on DMARDs and biologics guide explain eligibility and timing
- Wash your hands often, and ask visitors with a cough, cold or stomach bug to wait until they are better
- Keep a plan for winter illness — our winter viruses guide walks you through one
- If you get a chesty cough, our chest infection guide covers self-care and warning signs
Other steroid effects that matter with frailty
- Bones: longer courses can thin bones. Ask whether you need bone protection or a scan — see our bone density guide
- Falls: thinner bones make falls more serious. Our falls prevention guide covers strength, balance and home safety
- Blood sugar: feeling very thirsty, peeing more or feeling sleepy and confused can be signs of high blood sugar — contact a doctor or NHS 111
- Muscle weakness or great tiredness: tell your doctor, as these can be side effects that need checking
- Mood and sleep: take prednisolone in the morning with breakfast unless told otherwise, and tell your doctor about low mood, anxiety or confusion
- Eyes: the NHS suggests an eye test every 12 months if you take steroids long term
A checklist for carers
- Keep an up-to-date medicines list, the rheumatology advice line number and any steroid card together
- Know the person's usual self, so you notice new confusion, sleepiness or a drop in mobility quickly
- Do not wait for a fever before asking for advice
- Ask for a carer's assessment if you need backup support
Frequently asked questions
Should I stop prednisolone if I have an infection?
No — do not stop it yourself. Contact your GP, NHS 111 or rheumatology advice line. They may change your other arthritis medicines for a while, and sometimes you need a higher steroid dose while you are ill.
Do steroid injections carry the same risks?
Injections into a joint usually have fewer whole-body effects than tablets, but they can still affect the body for a while, and repeated or high-dose steroids add up. Ask your team whether the steroid card advice applies to you.
How long will I be on steroids?
It depends on your condition. In rheumatoid arthritis, steroids are often used for the shortest time needed while other medicines take effect. Your doctor will usually lower the dose gradually. See our rheumatoid arthritis hub for the bigger picture.
Sources and further reading
- NHS: Steroids
- NHS: Common questions about prednisolone
- NHS: Side effects of prednisolone
- NHS: How and when to take prednisolone
- NHS: Sepsis
- NHS: Rheumatoid arthritis treatment
- Versus Arthritis: Steroids
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Steroids for arthritis — how steroids are used and why they are tapered
- Rheumatoid arthritis — condition hub
- Chest infections and arthritis — self-care and warning signs
- Winter viruses and arthritis medicines — a sick-day plan
- Flu jab and arthritis — free NHS eligibility
- Vaccines on DMARDs and biologics — live and non-live vaccines
- Bone density — bone protection on steroids
- Flare-up guide — flare or something more serious