Prednisone and the treatment of rheumatoid arthritis

If you ask experts in rheumatology, they will all tell you they are reluctant to use a corticosteroid like Prednisone. It increases the level of blood sugars, causes weight gain, increases blood pressure, accelerates the possible development of heart disease, may cause ulcers and is associated with depression. When you put together a list like this and recognize this is only the headlines, you can see why experts might not want to give you prednisone. Except they do. No matter what the risks, there is one clear underlying truth. Prednisone is an excellent anti-inflammatory and, in clinical trials with low dosages, it has consistently been shown to:

• better regulate the auto immune system;
• reduce the swelling in joints;
• relieve tenderness; and
• slow down the progression of the arthritis.

The trend is to use dosages of between 5 and 10mg a day with the dosage tapered off after a few weeks. If the drug is continued for any length of time, it can be difficult to stop. Even at low dosages, some patients do not respond well to the tapering. A recent Cochrane study analyzed fifteen published research papers dealing with the monitoring of rheumatoid arthritis over a period of not more than two years. The conclusions were that:

• the earlier a patient began treatment with Prednisone, the better the outcome; and
• the combination of Prednisone with methotrexate, one of the auto immune drugs, significantly reduced the amount of damage to the joints and bones.

Unfortunately, there is no evidence as to whether Prednisone produces the same results when started after two years. There are also no studies comparing the use of Prednisone with other drugs. There is real resistance in the research community to comparative testing. However, it is clear that you need to avoid using Prednisone as the sole form of treatment. To avoid side effects, it is best used only in short bursts to reduce inflammation.

People with rheumatoid arthritis about prednisone:

Chuck

Wish it was safe all the time. This is a real wonder drug. Take it and I can move around with so little pain. But I’m just too afraid of the side effects so take it only as and when the pain really bites.

Anna

I’ve been taking Prednisone for nearly two years and, talking to others in the support groups, I’m going to have real problems in trying to stop. But for now, the additional weight and water retention is worth it. I can walk about and pick things up with no pain. The doctor is warning me about bone density, but I’ll face that when the tests give a better picture.