I have read the textbook side effects -- which aren't pretty. I
am temporarily on this medication, and I really hope I can transfer to
another medication gradually. I realize that doesn't always
happen. I know about weaning, etc. My mom was on this for two
years.
I would like to know if you have advice for habits or things that may
help me during my time on this medication. Foods to eat or avoid,
etc. Are there any particular things that help?
I realize it speeds the aging, etc. I want to do all I can to
help myself while on this drug. I am on a high dose to
start.
I am hoping for the best, but am so greatful for the relief it has
given me now. My life has been hell on earth for nearly three
months, and I didn't even realize how debilitated I was.
Thanks for any tips or inside info.
I was so elated to be relieved of my pain yesterday that I didn't care about side effects.
The more I read, the more terrified I am of the side effects. I
realize that this is going to be a long road ahead of me.
I am on 15 mg a day, and am supposed to wean down to 10 when I am
feeling better. I think I am going to try to do that sooner than
later now. I hope I can do this. I am feeling scared of
this drug now. It is a double edged sword indeed.
Just reading all your stories makes me want to wean down to the lowest possible dosage as soon as possible.
Hi
Glad you are feeling better. Prednisone is a wonder drug and can make us feel human again, but it does effect our bones, eyes, heart and cause weight gain. Do wean down on as low a dose as possible. Never quit cold turkey, that can cause heart problems.
Good job for asking lots of questions about the drug.
If you are on Prednisone temporarily, don't worry too much (unless you have an allergic reaction). This study show that people who are on it during their early RA for as much as 6 months or so have less damage than those who aren't on it. From what I read, 10-15 mg really is a pretty standard dose to be put on while you are waiting to get on a more permanent treatment, waiting for your first Rheumy appointment or even just to get things calmed down to a livable situation. It also works better with other disease modifying drugs, so don't hold off on that any longer than you have to.
A key issue for me - My doctor prescribeed Actonel (some prescribe Fosomax) to protect my bone density. I had a bone density scan in my early days, also, so there would be a baseline record. I had some slight bone density changes before I started Pred. I did not use it more than necessary. It is a good idea to have your sugars checked while you are on Pred too. I found it had a huge effect on my appetite. But unless I ate accordingly, I didn't have trouble with much weight gain.
There is no denying potential side effects. But for most people they are less horriffic than RA damage. Prednisone helps pain - sure. But it is also supressing the immune system that is attacking you. Likewise, it is reducing the inflammation in your joints (that causes damage) and in your bloodstream - which is another nasty topic alltogether. I am not recommending long term use either, of course. But is a valid temporary medication according to everything I have read. Here is the Johns Hopkins Article.
Good luck to you! http://www.hopkins-arthritis.som.jhmi.edu/news-archive/2002/ prednisone.html
"Low–dose prednisone is widely used for the treatment of rheumatoid arthritis (RA). When used in conjunction with disease-modifying antirheumatic drugs (DMARDs), it has been shown to retard radiologic damage in RA. However, few data are available on the efficacy of prednisone alone in this regard, or its safety. To address this question, van Everdingen, et al (Ann Intern Med 2002; 136:1–12) conducted a two year trial comparing low dose prednisone alone versus placebo for the treatment of early RA.
Methods: In a two year, randomized, double-blinded study the efficacy of 10 mg prednisone vs. placebo was examined in 81 subjects. All subjects had been diagnosed with rheumatoid arthritis within the past year and had active disease (>3 tender joints, >3 swollen joints, ESR > 28 mm/hr, > 30 minutes morning stiffness). No subjects had been exposed any DMARD prior to the study.
Patients were randomized to receive either placebo or prednisone 10 mg every morning with 500 mg supplemental calcium. Acetaminophen and NSAID use was allowed as were intraarticular steroid injections. Sulfasalazine was allowed as a rescue medication after six months if the investigator deemed the disease active.
Results: Thirty–five of 41 placebo subjects and 36 of 40 prednisone subjects completed the study. No subject dropped due to lack of efficacy or side effects, despite restrictions on DMARD therapy within the first six months. At baseline, there were no statistically significant differences in the demographic characteristics or disease activity parameters between the two groups, although there were some trends towards greater severity in the placebo group. After 6 months, 39 of 71 completers (20 placebo, 19 prednisone) received sulfasalazine.
At 12 and 24 months, there was statistically significant less radiographic progression in the prednisone group compared to the control group. Prednisone patients progressed at a rate of approximately 8 radiographic (Sharp) units per year, while placebo patients progressed at approximately 15 units per year. Overall, improvements in clinical efficacy parameters were not significantly different between the groups except for grip strength and 28–joint tender score (better in the prednisone group). However, prednisone treated patients took significantly less daily NSAID and acetaminophen, and had significantly fewer steroid articular injections, than the placebo treated subjects. This may have obscured any potential differences in the clinical parameters between the prednisone and placebo groups. Patients receiving prednisone experienced weight gain (77 to 80 kg, p=0.001) and an increase in mean serum glucose levels (5.1 to 5.9 mmol/L, p=0.01), while placebo patients did not. Prednisone treated patients also had an increased number of new vertebral bone fractures than placebo treated patients (5 versus 2).
Conclusions: Low–dose prednisone provides relief from rheumatoid arthritis symptoms particularly within the first six months and substantially inhibits progression of erosive joint damage in patients naïve to other DMARD therapies. However, as the authors note, because of its limited disease modifying properties, prednisone should be prescribed in conjunction with other DMARDs.
Editorial Comment: There are several important notations to make about this study. As the authors duly note, a placebo-controlled study design would not likely be approved now by human subjects or ethics committees. But, when it was initiated in the early 1990s, it was state–of–the–art and clearly yielded valuable information. Without the confounding addition of DMARDs, this study clearly demonstrates the disease modifying potential of low dose steroids. However, subjects receiving 10 mg prednisone daily still progressed at 8 Sharp units/yr. While this was lower than the placebo rate of 15 units/yr, it is much higher than the rates observed in recent studies in patients treated with methotrexate, etanercept, infliximab + methotrexate, or leflunomide. With these DMARDs, rates of progression are in the range of 0–2 units/yr. Each Sharp unit represents the equivalent of one erosion (or worsening of one erosion) or progression in joint space narrowing in one joint. Eight erosions, or progression of narrowing of eight joints, per year as demonstrated on prednisone treated subjects in this study, would not be acceptable given the higher superiority of the DMARDs listed above. Thus, the recommendation by the authors that prednisone should be adjunctive, rather than monotherapy, is appropriate.
The efficacy of prednisone must also be balanced against its potential long–term side effects. In this study, there was a tendency towards hyperglycemia and weight gain. Insofar as active RA can cause weight loss, some of the weight gain in prednisone patients could conceivably have been due to better control of disease activity and return to pre–RA weight rather than purely a side effect of prednisone. The increase in vertebral fractures is particularly concerning, however, and consistent with a recent report that even nasally administered corticosteroids are associated with decreases in bone density. (see report)
Finally, it would have been interesting to see how the addition of sulfasalazine altered the rates of progression in the two groups. Insofar as equivalent numbers of both treatment groups were started on sulfasalazine, its effect is probably equally distributed among the two groups. However, the subset in both treatment groups who received sulfasalazine might be expected to exhibit a slower rate of progression from 6–12 months than they had in the period of 0–6 months. "
Thanks for the info. That is really helpful. :) I have come to grips with it more since I first posted. I still need to learn all I can. It shouldn't be terribly hard to finally wean off of prednisone when the inflammation subsides. Fifteen mgs a day is not a very high dose.
I have PMR, not RA, and just started prednisone 9 wks ago. I tried to go with less than 10 mg/day, but it's rather seductive. After weeks of being so stiff and sore, I was so happy to "get my life back" that I found myself trying for complete relief, so went up to 15 mg/day and felt absolutely terrific the first month or so. Then I started feeling some side effects - nothing major, just some tingly feelings in my face - enough to make me uncomfortable and motivated to gradually reduce the dose. I'm now down to 10 mg. The only withdrawal symptoms were something like feeling hungover - tired, vaguely headachy, a little cranky.
Except ... my vision has gone wonky. I start the day with "normal" vision (which is pretty bad - I'm a "high myope") and my most recent prescription glasses, then by noon or so (4 hrs after my dose) I start to lose my distance vision, and by the time I drive home from work, I have to wear a pair of glasses I got maybe 10 years ago, when I first started needing bifocals. The next day, the same thing happens. I can't be 100% sure, but I'm pretty sure it's the prednisone.
I think if I were to do it over again, I'd probably settle for the lowest dose that allowed me to function with my normal lifestyle, and not one that made me feel like a million bucks for a few weeks! But the side effects might have been the same, regardless.
Let us know how it goes for you.
I AM BJ posted a fantastic article.I've been in an out of control flare with the RA and OA and couldn't sleep or walk for the pain in my feet especially (though new joints are being whacked with RA and OA right now, all over) ... doc gave me a prescription for prednisone 50 mg which is pretty high dose but it's the only thing that's helping me at the moment ... am already on Meloxicam and Sulfasalazine (not long enough to feel real benefits from this one yet) and mid stream being assessed with a rheumy so treatment and meds aren't quite all figured out for me yet but seeing rheumy again next week and hopefully he can make a plan for me and get me rolling.
The prednisone, from what I read, really is a wonder drug, and I call it "heavy artillery drug" because it can do a lot of damage too, but it really is the most powerful anti-inflammatory there is, I was told. Short term, as long as it works with me, I feel okay. I do worry about long term use as I suspect it's the only drug that really helps me right now and I really can't function without it's power right now.
50 mg really is high dose ... but I was in rough shape and needed a wonder drug to start helping to beat the inflammation down. I have some side effects but not bad that I'm aware of, and only have been on it a week so far. I assume that if doc prescribes more the next dose will be lower, and progressively so. To be able to walk across the floor or across the street to the corner store is really something! My feet still hurt, but it's liveable. Am not pathetically crying with the constant sharp pain, exhausted, but not sleeping. I live alone so have to function to a basic self-care degree. Meanwhile there are lots of diabetics in my immediate family (not me) and I'm multiple risks for osteoporosis so long term prednisone not ideal for this kid ;) (I;m 52)
Anyways ... good luck to you at finding the most effective and least side effects treatments for you ;)
I've been on 10 mg of prednisone for almost 3 weeks now. I have been on Enbrel for 5 weeks ( my first RX) The Pred has made a world of difference in my pain level, I am able to do just about anything now. I waited two months before I gave in to taking the Pred. The Enbrel just was'nt doing enough on it's own. I want to get off the pred, but I think MTX is my next option and I've read all the scary side effects with that one. Has anyone made that switch in meds? I'd like to know how you did, thanks Rain