Prednisone Uses for Rheumatoid Arthritis
This is the fourth post in a series about modern approaches to prednisone uses for Rheumatoid Arthritis. Please read the first post, Prednisone Dosage for Rheumatoid Arthritis, here at this link. Does prednisone have a disease modifying effect? Is it a double-edged sword? What’s the greatest risk of prednisone use that you may not have heard of?
Prednisone use with a DMARD
Experts disagree about whether prednisone can be considered a disease modifying drug. Large studies of long term low dose prednisone use have not yet been conducted so risks and benefits cannot be clearly measured, but for most patients prednisone use dramatically reduces symptoms of Rheumatoid Arthritis.
Prednisone has been shown in smaller studies to reduce bone erosions in early Rheumatoid Arthritis for some patients as long as its use is continued and as long as it is combined with another disease modifying antirheumatic drug (DMARD). “Because of their limited disease-modifying effects, glucocorticoids should be combined with disease-modifying antirheumatic drugs in patients with rheumatoid arthritis,” Annals of Internal Medicine.
One problem with prednisone uses for RA
Unfortunately the effectiveness of prednisone at suppressing Rheumatoid Arthritis symptoms can also work against the RA patient. Beginning DMARD treatment is often a difficult decision and prednisone could make it more difficult.
“The immediate clinical benefit of oral glucocorticoids, regrettably, could represent a double-edged sword: patients and their physicians may now believe that their improved status no longer warrants remittive therapy. A recent study supports this phenomenon, reporting that among patients followed consistently by rheumatologists but who were not taking DMARD, 37% received oral steroids. Similarly, it has been stated (without clear published evidence) that the immediate gratification afforded by steroids may make it difficult to discontinue them.”
Where do we stand with prednisone for use Rheumatoid Arthritis?
Some of things seem clear with this four part series on prednisone.
- Doctors do not all use prednisone in the same way to treat Rheumatoid Arthritis.
- Modern studies show earlier, lower doses of prednisone combined with DMARDs may be beneficial to slowing disease progression as well as gaining control of RA symptoms.
- Prednisone side effects may occur quickly in some patients or not at all in some others. Most are somewhere in between.
- Relying upon prednisone can lead to delay of treatments meant to bring remission (DMARDs).
Recommended reading:
- Prednisone Dosage for Rheumatoid Arthritis
- 3 Reasons to Stop Saying “Complications of Rheumatoid Arthritis”
- My Journey with Rheumatoid Arthritis Medicine
- Rheumatoid Arthritis Swelling: My Confession
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Hello, i now had RA FOR 20+ YRS, when i was first diagnosed by my PC doctor i was put on predisone, when i went to see a rheumatologist he took me right off predisone saying all that did was masked the symptoms, my question is are they finding out something different now? does it slow joint damage? i havn’t been on it since and am now on methotrexate and hydroxychloroquine
Kevin, I think early on it looked like a cure. It did put some into remission or halt the damage for others. But not as reliably as first thought & with great consequeces as I’m sure you know. Did you read the post a couple months ago about the history of Pred with RA ? click here. Read over the studies and articles linked to in this series. My rheum dr agrees with yours that it creates a “false reality.” Did you read in the first of this series that erosions are less with pred combined w/ a dmard, at a low dose, as early treatment ( less than 2 yrs of disease)…? I know doctors are trying to find ways to halt the disease progression while scientists also look for a cure.
GREAT INFO and LOVE the Rhinos!
Thanks Kelly for my 1st smile of the morning!
Thank you Connie! 😀
I am glad that my dr. didn’t increase the dose of prednisone (I am on 10 mg a day) and chose to start me on enbrel. I do feel the combination is helping. I was just a little surprised it took so many doses before I felt better. Yet, even with all the meds. rest and taking it easy seem to help the meds work better. Go figure? I’ve never been one to stay still for very long but you can bet I am changing my ways.
I agree Kristi, & it’s a tough lesson for us ambitious women. Hopefully, treatment will get you to the point that you can do much more. But most still live with that recovery time too. Did you read my theory called the Usage Principle? It’s kind of a joke, but all too true for many of us.
Wow, Kelly, the Usage Principal it the nail right on the head. I sent it to my grown children and their spouses. Hopefully, it will help them understand or maybe it will make me feel less guilty for not doing.
Thank you so much for the support-my life is really different with RA after it.
Dear Kristi, stop feeling guilty about being sick. :heart: I’m sure you do the best you can to fight the disease & do as much as possible in spite of it.
Prednisone is My Life Saver!!
Rosann – funny that makes me think of a Life Saver candy. haha. True, it’s the miracle medicine for many people.
My Rheumy just put me on a low dose daily for the next six weeks. I was on Plaquenil first but had a skin reaction so I went on a dose pack and feel great!!
I was just diagnosed last month and I feel the dr. doesn’t want to jump too quickly on other options…. I really don’t know how to feel about that just yet.
Reading these articles are wonderful!! Thanks so much for helping me understand my RA.
Blessings from TN
Diana
Good luck, Diana. Yes, pred can make some people feel like they don’t even have RA for a while. Only one month in, you are still very new to this! Great job getting out and getting informed! That is so important. There is a newly diagnosed w/ RA section here – up on the top menu. Maybe there will be something there will be something there that will help you.
As far as pred goes, I also recommend the first post on prednisone from earlier this year – the comments sections can be helpful too.
Hi Kelly, I do believe that there is some benefit in taking Prednisone. As you may recall, I was recently diagnosed this year with RA. Prednisone helps me significantly with inflammation and fatigue. I also take Mtx. Although, I might be getting off Mtx and starting Orencia shortly. I take 5mg of Pred and it seems to me that there are very slight to no side effects whatsoever. As a temporary addition to a person with RA’s treatment, I do believe it’s worth it. Now, if Orencia starts to work for me and i’m not experiencing inflammation or overwhelming fatigue then the Pred will not be needed, in my case. I believe in the use of Pred to help in the interim of finding the best combination of treatment for a patient.
Hi Elena, thanks for the good report on the pred. It’s good for us to hear how the low dose is effective for you and w/out much problem.
Good news about Orencia. Why would you go off mtx when you start it?
Good Morning Kelly,
Unfortunately, beside the fact that it showed that Mtx wasn’t doing anything, my white blood cell count is low due to Mtx. So the Dr. recommended that I stop. We still have to have more discussions about my treatment. My WBC has to be normal before I even start Orencia. We’ll see, I still need to talk to my Dr. more.. but i will keep you posted..
I don’t know if this will ever be read, but for now I have many questions. My 1st Rhummy only allowed me to take Pred for just enough time when I was first diagnosed wRA. I straightened my swan finger and was a real help. Then amost a yr. later he allowed me to take the short term pak. I had to leave my 1st Rhummy due to driving myself to a very large city, which I couldn’t do and had no ride. My second Rhummy was much closer and a place I could get to. She gave me an Rx for Pred adn then told me the next appt. not to take the Pred., so I kept the bottle I had filled. We moved and about 3 months after seeing my 3rd Rhummy a couple of times, my wrists and hands hurt so badly I asked him about the tapering pack. I also told him I had the bottle of Pred. I hadent taken, and he told me to take the 5mg 1xdaily plus 1/2 pill at night. Two months later I asked him about getting off the Pred. He scheduled a bone density test for this month. I had been on the Pred. for 3 months. The test results were not good and now I’m supposed to take a medicine (the one w/all the lawsuits)for osteoporosis. I am on MTX,Folic acid,and Humira. After reading the SE and cautions, I’m not sure if I will take the med. He also had me up my calcium w/D. Since being on Pred I have had night sweats and never had this before, even w/MTX, and a dry mouth and my teeth are showing signs of calcium depletion and I need a good denist to do fillings and a root canal, which at this point my dental insurance won’t pay for. The insert said w/dental problems not to take the Fosomax, so now I don’t know what to do and am losing faith in my present Rhummy. He is weaning me off the Pred, but way too late and I feel he should have listened to me early on. My little miracle pill has delivered a crushing blow so I guess I am one of the unfortunate ones. The osteop drug also recommends strength exercises. My shoulder has hurt for 2 wks after the last day I felt like exercie would help. I do a great side-step and duck walk since my knee and foot hurt too badly to do a lot of walking, and they want exercise-Ha! I take my vitamins, inc. the fish oil. I just wish I could call my 1st rhummy, but don’t know that I should. Thanks for letting me express myself.
Thank you for the article, Kelly. It’s strange to me to learn that so much of the science of medicine is really Russian Roulette, with our lives as the gun. It truly is up to us to be an advocate for our treatment, isn’t it?
I was diagnosed with RA officially in March 2011, although I haven’t been able to wear my wedding ring since October of the previous year, my activity level nil since around March of 2010, as well as complete fatigue for that time.
I started MTX upon diagnosis, working to 8 pills a day with little relief. Switched for a month to Arava with no effect. Placed back on MTX @ 8/day along with Enbrel. Ended up with a flare that that had me in bed for days, at two months into Enbrel. I was taken off MTX as it was obviously not working. Placed on Prednisone, 10 mg daily for the remainder of my 3 month “wait and see” period for Enbrel…which was up yesterday.
The Prednisone did the trick; I haven’t felt this good in years! No real side effects, small weight gain in a month, but there are other tummy issues being resolved that might account for that.
Rheumy wants to switch me to Cimza and continue full time with Predinsone, which scares me to the bone. My father in law was on major high doses of Prednisone (1000/wk) for his polymyocitis, from which he developed major swelling of the legs/feet, major stomach bulge, and caused him to become diabetic, among other things. Reading through your site, brought to light the other side-effects of Prednisone: osteoporosis, heart issues, mood swings. It’s a lot to comprehend.
So now I’m faced with the weighing of the options. Do I risk bodily damage to feel better, to be able to not only function at home & at work, but to actively play with my 9 year old boys; enjoying my life again? At this point, I’m leaning toward yes. Yet, thanks to your information, Kelly, I feel better armed and alert to the first signs of damage.
Thank you, Kelly. Your site has been a blessing to me since this RA journey has begun.
Blessings,
Tricia
Thanks, Tricia. I think that there is some benefit to bringing down inflamation if the pred works on you – that is a bit more than just making you feel better. Of course, pred has benefits and risks to weigh, but this is important to consider because it could slow some damage as well.
There are several pages on prednisone you can check out – and lots of comments. People post their own opinions so you can get a variety of views in the comments pages too.
Kelli when you did your three day experiment, on the third day did you just stop cold turkey? Or did you Wean yourself I know when I’m on prednisones for flares I take so much for five days and then I’m going down so that my body gets used to it slowly just wondering? Diane
Hi Diane. No I went back to the daily dose of about 10 which allows me to survive but with a lot of symptoms still.
There are different methods for short term use. Some docs prescribe a “taper” and others a “burst” with no taper. If it’s short term, a burst is fine and there’s really no “cold turkey” danger. Stopping cold turkey after long-term use would be the danger since the body slows or stops producing its own steroids. I hope this helps.
This might also help https://www.rawarrior.com/when-you-cant-get-off-prednisone/