This Steroid Is Commonly Prescribed To Help With Ra Flares Heres What You Need To Know Before You Start It
People with rheumatoid arthritis who are prescribed corticosteroids such as prednisone often have questions and concerns about them. And its not hard to see why: These medications come with a long list of side effects, ranging from insomnia and weight gain to high blood sugar and thinning bones. But when corticosteroids like prednisone are judiciously in the right patients, these drugs can be safe and effective, according to Anthan Tiliakos, DO, an assistant professor in the division of rheumatology at Emory Healthcare in Atlanta.
There is some controversy in rheumatology about the use of drugs like prednisone for rheumatoid arthritis, and some doctors believe they have no place in the treatment of RA, he says. Im of the opinion that it can be an excellent medication in certain circumstances.
To help improve the understanding of how prednisone and other corticosteroids such as dexamethasone and methylprednisolone can help control rheumatoid arthritis, we asked Dr. Tiliakos to answer some of the most common questions and concerns patients have about the drug.
Nighttime Prednisone Could Address Morning Stiffness In Ra
During sleep, when patients appear most still, their inflammatory systems are most active. Rheumatology Network interviews Maurizio Cutolo, M.D., who recommends prednisone at night.
Rheumatologists have long struggled with a contradictory aspect of their work. During sleep, when patients appear most still, their inflammatory systems are most active.
Physicians who treat rheumatoid arthritis have long noted the morning stiffness that results. But, says Maurizio Cutolo, M.D., a professor of rheumatology at the University of Genoa, Italy, many physicians dont take the next logical step: treating the inflammation with low-dose glucocorticoids administered at the night.
Dr. Cutolo reviewed the literature on this approach in a recent article for the journal RMD Open. Not only does taking prednisone at bedtime work better, the newly available delayed-release formula takes effect at 3 a.m., when it is needed the most, he says.
Studies as far back as 1964 have documented the advantages of treating inflammation at night. But physicians have often followed a more intuitive approach, recommending patients take prednisone at the time of day when symptoms are at their worst, he told Rheumatology Network.
Usually the GP and the specialists give the low-dose in the morning, he said. This is not completely wrong, but it is not the optimum. It does not follow the concept that hormones must follow the circadian rhythm of endogenous production.
When Are Steroids Used
When are steroids used? Steroids are used sparingly for conditions such as RA, because of the side effects, in the smallest possible dose for the shortest time. They can be very useful at the start of treatment either as a joint injection or an occasional intra-muscular or intravenous dose.
- Steroids can be very effective in treating a flare up of RA by controlling the symptoms quickly
- Steroids are used with caution and the doctor will have various considerations before prescribing the drug
- When reducing a steroid dose, your doctor will recommend a very gradual reduction over time which allows your body to re-adjust to producing steroid naturally.
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Watch: Switching Rheumatoid Arthritis Medications
This video is part of an educational project from researchers at Yale University, Berkshire Medical Center, Carnegie Mellon University, Hospital for Special Surgery, CreakyJoints and the Global Healthy Living Foundation, and ArthritisPower. It was made possible with support from the Rheumatology Research Foundation. Watch more videos from this series here.
Can Prednisone Cause Problems
Along with its useful effects, prednisone can cause unwanted side-effects which your doctor will discuss with you. The benefits of taking prednisone usually outweigh the side-effects however, they can sometimes be troublesome. Although not everyone experiences side-effects, and some will improve as your body adjusts to the new medicine, speak with your doctor or pharmacist if you become concerned about any of the following:
|Common prednisone side-effects|
|If these become troublesome, speak with your doctor|
|Long-term treatment with prednisone may cause other unwanted effects||If you have any symptoms which cause you concern, you should arrange to see your doctor for advice|
For more information about side-effects which are possible when prednisone is taken long-term, see the separate condition leaflet called Oral Steroids.
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Subjects Who Took The Oral Steroid Reported Pain Relief Other Improvements
The results? We found that treatment with prednisolone led to a substantial reduction in finger pain after six weeks, almost a 40 percent improvement in the prednisolone group versus almost 10 percent improvement in the placebo group compared to baseline. In terms of function, there was a 72 percent improvement in the prednisolone group versus 33 percent in the placebo group, reported Kroon. She added that it is unknown whether a higher dosage would have been effective, but at this moment there is no indication that the benefits of a higher dosage outweigh the higher risk of adverse events.
How Much Prednisone Will I Take
The amount of prednisone your doctor prescribes will depend on your specific condition and the stage of your disease. You might get a high dose for a short time if youâre having a flare-up. Or your doctor may put you on a lower dose for what they call bridge therapy while youâre waiting for another medication to take effect. Many people take a low maintenance dose for a long time to keep inflammation levels in check.
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Polymyalgia Rheumatica And Giant Cell Arteritis
Both polymyalgia rheumatica and giant cell arteritis are treated with oral corticosteroids. Lower doses are used initially in polymyalgia, whereas higher doses, e.g. 40-50 mg/day are used in giant cell arteritis. The drugs are continued for a few weeks and then, depending on the symptoms and laboratory indices, e.g. ESR or C-reactive protein, the dose can be reduced to the lowest maintenance dose possible e.g. 5-10 mg/day. Both conditions require treatment with steroids for a period of about two years. Unfortunately, in older patients, the dramatic early relief of symptoms is complicated by a high frequency of adverse effects after prolonged corticosteroid use.
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Why Is It So Important To Taper Prednisone When You Stop Taking It
If your rheumatologist says you may be able to stop taking prednisone for rheumatoid arthritis or cut your dosage, dont be tempted to speed up the recommended weaning process. Not tapering prednisone properly can lead to adrenal insufficiency, a condition in which the body doesnt produce enough of the hormone cortisol.
The adrenal glands make a natural amount of steroids every day, and if youre on a glucocorticoid like prednisone for a long period of time, the adrenal glands may shut down or go to sleep for a little while, Dr. Tiliakos says. Tapering prednisone is an attempt to wake up your adrenal glands so they can start doing their job again.
In fact, one of the reasons doctors prescribe prednisone for rheumatoid arthritis more often than other glucocorticoids is because its available in so many dosages, which makes it easier to taper by smaller increments if necessary, he adds.
Methotrexate And Folic Acid Dose Recommendations
Because of its effectiveness and established safety profile, most patients who have RA take methotrexate at some point for treatment, usually by mouth. The typical dose starts at about 5 mg to 10 mg per week. However, in cases where high-dose oral methotrexate treatment is needed, the dose can be increased to about 25 mg per week, or even higher if necessary.
For patients in whom treatment based side effects become an issue, the proper dose of methotrexate can also be given as an injection under the skin. Sometimes, simply switching the dose delivery method from an oral methotrexate tablet to a methotrexate injection is enough to help. Splitting the dose into two daily doses instead of one single dose may help as well, or you can ask your doctor about anti-nausea medications.
Also, as the University of Michigan reports that methotrexate stops the growth of rapidly dividing cells, such as embryonic, fetal, and early placenta cells. No dose of methotrexate is safe during pregnancy. In fact, doctors often use this drug as a treatment for ectopic pregnancy, a potentially dangerous condition which involves a fertilized egg attaching itself to the fallopian tubes versus the uterus, essentially terminating the fetus.
As far as folic acid is concerned, doses in the range of 5 to 10 mg per week have been shown to reduce methotrexate toxicity. Folinic acid, a healthy form of folate which doesnt require any type of enzyme conversion, can also be found in some natural foods.
Study Asked: Is There A Better Way To Control Hand Oa Pain
A small study published November 11, 2019, in The Lancet looked at the effect of low doses of prednisolone, an oral steroid, on pain and function in patients with hand osteoarthritis. Currently, there is an unmet need for effective therapies for this disease. While several therapeutic options for hand OA are available to alleviate symptoms, the efficacy of these treatments is modest at best, said the lead author, Féline Kroon, MD, a rheumatologist in training at Leiden University Medical Center in the Netherlands, in a press release.
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How To Store Prednisone
Maintain complete separation of all medications from childrens reach and sight, and store them in a cool, dry location away from direct sunlight and heat. Its possible that Prednisone can help you manage a long-term illness, but it wont cure it. You should keep taking Prednisone even if you feel better. Before you stop taking Prednisone, talk to your doctor.
If you stop taking Prednisone suddenly, your body might not have enough of its steroids to work at its best. Extreme weariness, weakness, decreased movement, upset stomach, and weight loss are all possible side effects of this condition. Contact your doctor if you develop any of these or other unexpected symptoms while using Prednisone at a lowering dose or after stopping the medicine.
Why Are Corticosteroids Used
Recent studies initially by Kirwan and subsequently by several other groups have shown that when initiated alongside disease modifying antirheumatic drug therapy, steroids are associated with a decrease in radiologic progression.1-4 In one longer study, the difference at four years, while statistically significant, was hardly clinically importanta mere four Sharp score units.2 Nevertheless, a DMARD effect exists. In the most recent study, patients with less than one year of RA were treated with a tight control strategy using methotrexate along with 10 mg of prednisone daily .3 At the study completion at the end of two years, there was no observed difference in median Sharp scores, but the percentage of patients with new erosions was statistically different 78% of those on prednisone and methotrexate were still erosion free compared to 67% on methotrexate alone. The clinical benefit that was very obvious in the first months of the trial had largely disappeared by the end of the first year of treatment. This is a recurrent theme of studies that use prednisone to treat RA and, despite the radiologic difference observed at two years, Kirwan noted that the clinical effect did not persist into the second year.
Thus, the rationale for persistent long-term clinical benefit does not seem to hold up when formally tested in a controlled trial rather than using what Dr. Ted Pincus has coined eminence-based medicine.
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How Long Should I Take It
Similarly, the longer youre taking prednisone, the greater risk of side effects. In fact, some of the more serious side effects you hear about with prednisonelike thinning of bones and increased risk of infectiontend to be side effects from long-term use, says Dr. Deane . Again, he suggests going into treatment with a mindset that you’ll use prednisone for a short timeideally, two weeks or less.
How Do You Taper Off Prednisone
No matter the dose, if youâve been taking prednisone for more than 2 weeks, you shouldnât stop suddenly. Your doctor will help you decrease your dose slowly so your body has time to increase its own cortisol production. Follow your doctorâs instructions about tapering carefully. If you quit all of a sudden, you could have symptoms like:
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What Does Prednisone Do
Prednisone, like other corticosteroids, quickly lowers inflammation, which cuts down on pain, redness, and swelling. It also dials down your immune system. Under normal conditions, this system protects you against things like viruses and bacteria that cause infections and diseases.
Sometimes your immune system overreacts and attacks your body’s tissues. Prednisone stops that attack. Thereâs also proof that low-dose prednisone may slow joint damage in people with rheumatoid arthritis, but not as much as other arthritis medications do. It can also cause unpleasant long-term side effects.
Corticosteroid Use In Early Ra
The effect of corticosteroids, on both clinical and radiographic parameters, in early RA has been the subject of considerable research effort in recent years .
However, differences in methodology, variability in the type and dose of DMARD used, differences in corticosteroid dose and variable duration of therapy combine to make it difficult to compare the studies directly and to draw firm conclusions regarding efficacy and toxicity of corticosteroids in early RA.
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Caution: Prednisolone Cannot Be Safely Taken Long
Prolonged exposure to prednisolone can have a range of side effects, such as hyperglycemia, hypertension, and the development of osteoporosis and its associated risk of fractures. Kroon said, In our study we found no safety signals for a six-week course of prednisolone 10 mg daily in this patient population. Nevertheless, since this trial only provides evidence for the effectiveness of a six-week course of prednisolone 10 mg daily, and in light of the risk of complications, prescription of prednisolone for prolonged periods of time in patients with hand osteoarthritis should be discouraged.
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Important Things To Remember
- You must see your rheumatologist regularly to make sure the treatment is working and check for possible side effects.
- You should have regular blood tests as suggested by your rheumatologist.
- Do not increase or reduce the dose of prednisolone or prednisone unless your doctor or rheumatologist tells you to.
- It is important to tell your rheumatologist if you have a new serious illness such as a serious infection, cancer or heart failure.
- If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
- If you plan to become pregnant, you must discuss the timing with your rheumatologist.
For more information see the Prednisolone & Prednisone printable information sheet.
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Steroids And Immunisation/ Vaccination
- It is recommended that protection against pneumococcal infections is important. These can lead to pneumonia, septicaemia or meningitis. Protection is best given before steroids begin but it is possible for this immunisation to be given during low dose steroid treatment
- The annual flu vaccination is also recommended
- In general, if you are on steroids, immunisation is only possible with a low dose regimen of steroids. There is no evidence that immunisation will worsen RA
- For anyone who is immunosuppressed live vaccines cannot be given. These are measles, mumps, rubella , chickenpox, oral polio , BCG, oral typhoid and yellow fever. If steroids have not yet been started it is important to seek advice on how long a gap to leave after having a live vaccine
Folic Acid A Must For Ra Patients Taking Methotrexate
Though it may not seem like a supplement could do much to ease methotrexates potentially uncomfortable side effects, the Arthritis Foundation calls folic acid an absolute must. This is because it doesnt interfere with the drugs positive treatment effects, yet it does ease the angst that some people with RA develop in their gastrointestinal tract when taking this prescribed medication in its normal dose.
Additionally, one piece of research published in the journal Arthritis Research & Therapy explains that methotrexate toxicity can become an issue for patients with RA, especially if they take this drug over long periods. Essentially, one of the main problems occurs when it comes time for patients to be taken off methotrexate as withdrawal occurs as much as 50 percent of the time.
As a result, some doctors are hesitant to prescribe this drug as a treatment option to patients with RA. However, folic acid reduces this concern for these doctors in that it helps reduce methotrexate toxicity. Even in smaller doses, it has proven to be effective in this regard. There are other ways to reduce toxicity as well, such as by taking additional substances, like calcium folinate for instance.
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What Are The Possible Side Effects With Long
- If steroids need to be used for longer than a month or in slightly higher doses than the generally accepted low dose regimen it is likely that the immune system will be suppressed. This is called immunosuppression
- Be aware that taking steroids can suppress or mask the effects of an infection. It is better to get advice at the first indication that an infection is starting than to wait and hope that it will come to nothing. Be safe!
- Rarely, there is a possibility that a number of side effects could develop such as diabetes, thinning of the bones and weight gain which might show as a rounded face
- Remember that the consultant specialist will be very aware of these possibilities, will discuss them fully and will make every effort to control the RA without risking long term problems