Is Prednisone Over-Prescribed?

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Reading the headlines you may wonder: is prednisone over-prescribed?

Is prednisone over prescribed?

Sensational headlines are not new. But I did a double take when I read Steroid Over-Prescribing Persists in RA. My natural reaction is to defend patients: “Steroid overuse? Who would take steroids unnecessarily? This is just another side effect of pharma ads leading the public to believe RA is basically cured.” I’ve encountered this attitude everywhere, including doctor’s offices: Biologics solve the RA problem, so why would you need steroids? So, is prednisone over-prescribed? Let’s have a look.

This Medpage Today article is a discussion of a study of about 16,000 people with rheumatoid disease (PRD) in the UK who were followed from 1992 to 2009. The average steroid dose was 7.5 mg. The original study was published in Arthritis Research & Therapy: Half of UK patients with rheumatoid arthritis are prescribed oral glucocorticoid therapy in primary care: a retrospective drug utilisation study. The research itself is important and the results are interesting.

But look at how the press covered this study:

1) Too many PRD are taking too much steroids.

“Almost half of patients with rheumatoid arthritis (RA) in the U.K. receive glucocorticoids from primary care physicians, and of those who are prescribed glucocorticoids, more than half receive more than 10 mg a day.”

RA Warrior Response: Ok, about half of PRD still need steroids despite whatever modern treatments are available. If you spend time listening to patients or reading clinical studies, that’s not a surprise. What does it tell me that more than half “receive” over 10 mg per day? It tells me that the miracle drugs are not miraculous, and many people still have inflamed joints.

2) Steroids ease the pain but they have side effects so they should be used less.

“Glucocorticoids have been used for RA for more than 60 years, and are effective for easing the pain and swelling associated with the disease. However, these drugs are associated with many potentially serious adverse effects, and current guidelines recommend that they be used for the shortest possible time and at the lowest effective dose.”

RA Warrior Response

  1. Yes, all patients with all conditions must consider whether medicine’s benefits outweigh its risks. Do you realize that weighing risks and benefits is also a huge issue with DMARDs (disease modifying drugs) and Biologics? People have to consider those side effects as well.
  2. Unfortunately, “the shortest possible time” may be a long time if other drugs are not effective and the disease is active.
  3. Unfortunately the “lowest effective dose” varies based on genetic differences that PRD cannot control. While 5 mg may work for one person, it may take 20 mg to get the same response in another person.

3) Use a variety of alternatives because steroids are risky.

“Given the variety of treatment options available for RA, it is important to consider the individual patient’s specific comorbidities and risk of developing glucocorticoid side effects and introduce alternative therapies where appropriate.”

RA Warrior Response: This is technically true, because risk to benefit assessment should always be done for every treatment. What should also be considered, but isn’t discussed in this article, is how disabling rheumatoid disease is. This is the reason steroids are used when nothing else works. How can we neglect to consider the cost of not being able to move? It’s significant in at least two ways.

  1. Disability makes a person less productive for herself, her family, and society.
  2. Bone and muscle loss results from less weight-bearing activity.

SUMMARY: The neglected facts about steroids

Is prednisone over prescribed?Is prednisone over-prescribed, a needless holdover from the 1950’s? Is it a foolish easy way out for those who ignore the cure? Or are steroids one of the valuable classes of medicine to help mankind?

The debate goes on. But usually without mentioning how steroids may slow damage in rheumatoid disease. Even very low doses of steroids have been shown to reduce radiographic progression (rheumatology-speak for evidence of damage seen on x-rays). Many believe that inflammation is what leads to damage. So it makes sense that reducing inflammation can reduce damage. One international study showed less damage when prednisolone was used: Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: A multicenter, double-blind, placebo-controlled trial

What do you think: is prednisone over-prescribed?

Steroids were invented for rheumatoid disease. But today they are used in many forms for a multitude of diseases, including cancers. No one denies they have a dark side. And no one wants to need them. But are they prescribed to PRD needlessly? Or do most people use them when nothing else works?

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Kelly Young. All rights reserved.

This entry was posted on Tuesday, January 12th, 2016 at 4:15 pm and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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