Does Prednisone Help Rheumatoid Arthritis

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.

Does Route Of Administration Of Corticosteroids Matter

Furtado and colleagues studied 69 RA patients with 612 swollen joints and randomized them to polyarticular injection with triamcinolone or equivalent doses of IM triamcinolone. Over 6 months, the intra-articular group had significantly better American College of Rheumatology 20, 50 and 70 responses, and fewer adverse events than IM group. Blood pressure was lower in the IA group and they sought help less often as measured by calls to the physician or hospital unit.

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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Methotrexates Possible Side Effects

So what are methotrexates possible side effects? The most common negative effects associated with this particular medication are gastrointestinal symptoms like nausea, vomiting, and ulcers . Some doctors have also reported that patients have developed mouth sores, fatigue, headache, dizziness, or shortness of breath. It may cause hair loss as well.

Though the risk is small, methotrexate therapy can also cause liver damage, so patients who take the medication on a regular basis as a form of RA treatment need to have routine blood tests taken by their doctor to make sure their liver remains healthy. To reduce any further risk of liver damage, patients taking methotrexate should also avoid drinking alcohol. If damage is suspected, your doctor may request a liver biopsy.

In a few rare cases, methotrexate has been known to cause lung inflammation or a decrease in white blood cells or platelets, a condition which can lead to bone marrow suppression. According to University of Pittsburg Medical Center , bone marrow suppression occurs when the marrow doesnt make the normal amount of blood cells.

Ultimately, this can instigate other medical conditions such as anemia, leukopenia, neutropenia, or thrombocytopenia says the UPMC. By limiting the likelihood of bone marrow suppression then, youre also reducing your risks of these other conditions. Fortunately, routine blood testing by your doctor can identify these potential issues so they can be stopped before they progress.

Important Things To Remember

• While taking prednisolone you should see your treating doctor regularly to make sure the treatment is working as it should and to minimise any possible side effects.
• You should not stop your treatment unless your doctor tells you to.
• You should not increase or reduce the dose of prednisolone unless your doctor tells you to.

This information has been produced by the Australian Rheumatology Association to help you understand the medicine that has been prescribed for you. Please read it carefully and discuss it with your doctor. The information in this sheet has been obtained from various sources and has been reviewed by the ARA. It is intended as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned. This information is not intended as medical advice for individual problems nor for making an individual assessment of the risks and benefits of taking a particular medicine. It can be reproduced in its entirety but cannot be altered without permission from the ARA. The NHMRC publication: How to present the evidence for consumers: preparation of consumer publications was used as a guide in developing this publication.

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Reducing Pain Without Medications

You can help to reduce flare-up pain symptoms without medication through physical activity and by maintaining a healthy weight.

The Centers for Disease Control recommends getting at least 150 minutes of moderate physical activity each week, though make sure you choose activities that protect your joints, such as walking, bicycling, and swimming. For people who have excess weight, losing just 10 or 12 pounds can improve pain and function.

Important Information About All Medicines

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What Role Do Corticosteroids Play In The Treatment Of Rheumatoid Arthritis

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Corticosteroids are potent anti-inflammatory drugs that are commonly used in patients with RA to bridge the time until treatment with DMARDs is effective. These agents are effective adjuncts to DMARD or NSAID therapy. Timely dose reductions and cessation are important because of the adverse effects associated with long-term steroid use. Corticosteroids can be administered by oral, IV, or intra-articular routes.

When Buttgereit et al studied circadian rhythms in 288 patients with active RA, half of whom were randomly assigned to a modified-release prednisone tablet and the other half to an immediate-release prednisone tablet, there was a clinically relevant reduction of morning stiffness of the joints with the MR product as compared with the IR product.

A 9-month extension of the same study showed that the MR prednisone taken at bedtime was well tolerated and provided a sustained improvement. A third study that added low-dose MR prednisone to existing DMARD treatment also showed improvements in RA signs and symptoms, including a reduction in morning stiffness as compared with baseline .

References

Adding Prednisone To Methotrexate May Be Helpful In Early Ra

May 23, 2017

NEW YORK Adding prednisone to methotrexate for early rheumatoid arthritis results in a lower initiation rate of a biologic, better radiographic outcomes and no steroid-related side effects, researchers in the Netherlands say.

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• Higher Tocilizumab Dose Plus Methotrexate Best for Early RA

Although biological disease-modifying anti-rheumatic drugs have led to better control of RA and improved functioning and quality of life, they cost more than conventional synthetic DMARDs, carry a higher risk of severe infections and dont work well in up to a third of patients, Dr. Mary Safy and colleagues at University Medical Center Utrecht point out in Annals of Rheumatic Diseases, online April 27.1

To help optimize early RA treatment, the team analyzed post-trial follow-up data on 218 participants in the CAMERA-II trial, in which patients received methotrexate plus 10 mg prednisone or placebo daily.2 Adding prednisone resulted in a significantly faster reduction in disease activity, less corrosive joint damage after two years of treatment and less frequent initiation of a tumor necrosis factor inhibitor-based treatment.

In the current study, the team looked at whether those improvements persisted after the trial, when prednisone was tapered and stopped. Median post-trial follow up time was 6.7 years for the methotrexate plus prednisone group vs. 6.6 years for methotrexate plus placebo.

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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

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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How Long Can You Safely Use Prednisone For Rheumatoid Arthritis

Unfortunately, theres no simple answer. Experts know that the risk of serious side effects of taking prednisone, such as osteoporosis and diabetes, increases with long-term use and higher dosages. Whats controversial among rheumatologists, Dr. Tiliakos says, is whether patients can safely take low doses of prednisone for long periods of time.

Some say its okay for an RA patient to take 5 mg of daily for years if need be, while others think prednisone is dangerous and want their patients off it completely, Dr. Tiliakos says. Im of the school of thought that its acceptable to take 5 mg for long periods of time, though it depends on the patient.

The good news is that most people with RA can be sufficiently treated with just 5 to 10 mg of prednisone, he adds. Larger doses of prednisone which can be as high as 60 mg a day are more likely to be used in RA patients who are experiencing extra-articular symptoms such as eye or lung inflammation.

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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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.

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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Reaction To The Research

My fatigue is by far the most annoying everyday part of life with RA, Shirley Hanover, 58, a resident of Connecticut who has lived with rheumatoid arthritis for 10 years, told Healthline.

She and Norma Harvey, 46, a resident of Ontario, Canada, who has had RA since her 20s, both would like to see a treatment for their tiredness.

In my mind, a miracle cure for rheumatoid disease involves not just the reduction of pain but also the management of fatigue. Im always so tired, Harvey told Healthline.

So is there hope for people like Hanover and Harvey?

Diederik De Cock, PhD, a researcher at KU Leuven in Belgium and an author of the study, thinks so.

The early course of the disease could provide an opportunity to manage fatigue, he said in a press release.

Experts say such a treatment is needed.

In addition to pain, profound fatigue reduces the quality of life for many people, even more than the swelling of the joints, Dr. Iain Mcinnes, president-elect of the European League Against Rheumatism, said in a press release. But, doctors often dont pay enough attention to patients fatigue.

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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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.

Low Dose Prednisone For Rheumatoid Arthritis

Steroids like prednisone are occasionally used for rheumatoid arthritis. They help decrease inflammation and suppress the immune system, but have been thought to have few effects on the bony deformities that occur with rheumatoid arthritis. However, recent studies may have shown that there is some effect of low dose prednisone on the disease process itself. Low dose prednisone may be used orally at the beginning of treatment until other medications like methotrexate take effect. Steroid injections directly into the joints are also occasionally used to decrease inflammation. Some prescribers will combine methotrexate and low dose prednisone to treat rheumatoid arthritis.

The many side effects limit the use of steroids for rheumatoid arthritis. Patients must watch for weight gain, increased blood sugar and bone loss when taking prednisone and other steroids. Long term use of steroids may make it difficult to stop them as the body becomes used to steroids over time.

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