Do Steroids Affect Blood Test Results in Rheumatology Patients?

I would like to inquire if steroids can affect the results of blood tests in immunology and rheumatology?

Hello Doctor: In recent months, the joints in my fingers have started to swell and hurt gradually, making it difficult to bend or extend them, and I cannot apply force.
The bones near my wrists also hurt, and I experience stiffness and soreness in my finger joints and knees upon waking up, as well as after periods of inactivity.
My wrists cannot bend inward without pain, and the situation is worsening, so I consulted a rheumatologist.
A few days before the appointment, I suddenly experienced severe, intermittent itching all over my skin.
Two days before the appointment, I visited a dermatologist and received a steroid injection for itching relief.
The next day, the condition of my finger and knee joints improved significantly, and they were almost pain-free (I didn't realize at the time that it was due to the steroids).
When I visited the rheumatologist the following day, my joints felt great and were completely pain-free, so I had blood and urine tests done.
However, the day after that, my joints began to swell and hurt again.
Later, when the test results came back, they indicated normal findings, suggesting no rheumatoid arthritis or lupus, but I still have these symptoms in my fingers, wrists, and knees, and I am unsure how to proceed (and my skin continues to itch intermittently).
I only thought about whether the test results were influenced by the steroid injection after the appointment, and I did not ask the doctor at that time.
Therefore, I would like to know if steroids can affect blood test results.
If there is no impact, I would also like to ask which specialty I should consult for diagnosing and treating these symptoms.
I hope you can provide some advice.
Thank you.

Nìmíng, 20~29 year old female. Ask Date: 2021/07/22

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
The administration of steroids may only affect certain laboratory results, including white blood cell counts, but it should have minimal impact on the indicators for rheumatic diseases or allergic conditions.
I believe your symptoms include both allergic and rheumatic manifestations, so it would be best to consult a rheumatologist.
If you did not clearly describe your symptoms during your visit to the rheumatologist, I recommend that you see a rheumatologist again and provide a detailed description of your symptoms; this may help resolve your issues.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about you.

Reply Date: 2021/07/22

More Info

Steroids, particularly corticosteroids, can indeed have an impact on various blood test results, especially in the context of rheumatology and autoimmune diseases. When patients receive steroid injections, such as the one you had for your skin condition, it can lead to temporary relief of symptoms, which may mask underlying issues. This is likely what you experienced when your joint pain improved significantly after the steroid injection.
Corticosteroids work by suppressing inflammation and modulating the immune response, which can lead to a decrease in symptoms associated with conditions like rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). However, this suppression can also affect laboratory results. For instance, steroids can lower white blood cell counts, particularly eosinophils, and can also influence markers of inflammation such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). In your case, since your blood tests returned normal results for rheumatoid arthritis and lupus, it is possible that the steroid injection influenced these results by reducing inflammation temporarily.

Regarding your symptoms, the fact that you are experiencing joint pain, stiffness, and skin issues suggests that there may be an underlying inflammatory or autoimmune condition that needs to be addressed. The normal lab results do not necessarily rule out these conditions, especially if you have persistent symptoms. It is crucial to communicate your ongoing symptoms clearly to your rheumatologist, as they may need to consider other diagnostic tests or imaging studies to get a comprehensive understanding of your condition.

If your symptoms persist or worsen, it may be beneficial to seek a second opinion from another rheumatologist or to discuss the possibility of further diagnostic testing. Conditions like RA or SLE can sometimes present with atypical symptoms, and it is essential to ensure that your treatment plan is tailored to your specific needs.

In terms of which specialty to consult, continuing with a rheumatologist is advisable given your joint symptoms. However, if your skin issues remain problematic, consulting a dermatologist may also be beneficial, especially if the itching and skin reactions continue. A multidisciplinary approach can often yield the best outcomes for complex cases involving both joint and skin symptoms.

In summary, while steroids can affect blood test results, they also provide significant symptomatic relief. It is essential to maintain open communication with your healthcare providers about your symptoms and any treatments you are receiving to ensure that you receive the most appropriate care. If necessary, do not hesitate to seek further evaluations or opinions to address your ongoing health concerns effectively.

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