Corticosteroids can have tremendous therapeutic benefits but can also cause severe side effects and toxicities. Judicious use of these agents plays an important role in many rheumatic diseases. Careful selection of the initial dose, aggressive attempts to taper doses, prescription of supplemental calcium and vitamin D, and consideration of steroid-sparing agents in patients who remain dependent on corticosteroids for disease control are the foundation of proper use. The roles of corticosteroids in treatment of rheumatoid arthritis are complex and remain, to some extent, controversial.