Prednisone Dosage for Rheumatoid Arthritis

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Magician with wand - prednisone seems magicalThe prednisone debate is actually more than one debate. How much? For how long? Does it only mask symptoms? Or does it slow the disease? At what risk? The risk / benefit analysis of prednisone is particularly difficult because both the risks and the benefits have been studied with such a wide range of doses. In this series of posts, we’ll examine some the most modern theories and studies on prednisone use for Rheumatoid Arthritis.

   

History of prednisone dosage for Rheumatoid Arthritis

Back when my grandfather and some of our older warriors took glucocorticoids, it was cortisone they took. The doses were high. The results were great. The side effects were devastating.

Soon medicine recognized the dangers and glucocorticoid use became much more conservative – even scarce. Eventually, prednisone gained the trust of doctors because, though a weaker form of steroid, it retains the legendary effectiveness. Steroids have become the miracle drug for many conditions, especially temporary or acute illnesses. However, for Rheumatoid Arthritis, the debate continues.

“More than 50 years after their introduction into clinical practice, the possible disease-modifying effect of glucocorticoids remains unresolved, as do the differing opinions on their side effects. This leads to totally contradictory statements by respected opinion leaders concerning the role of glucocorticoids in the management of RA,” Arthritis and Rheumatism, Germany.

Types of prednisone dosage for Rheumatoid Arthritis

Bridge: These days, prednisone for Rheumatoid Arthritis is often recommended as a bridge medicine. It temporarily suppresses the symptoms of RA, giving slower acting treatments time to take effect. This is prednisone at its best, showing off immediate and glorious results and then exiting stage left.

Bursts: Another common way that Rheumatoid Arthritis is treated with prednisone today is with short term higher doses in a taper fashion. A prednisone burst is often several days to treat an RA flare, but can be longer. It varies a great deal according to the philosophy of the rheumatoid specialist.

Long-term low dose: When DMARDs are not effective in controlling Rheumatoid Arthritis, prednisone may be used as a long term component of the treatment. You might find it interesting to read the comments about the length of time many RA patients have used prednisone on this previous post – click here. There are not a lot of articles advocating long-term use of glucocorticoids, but there are a lot of doctors prescribing them. The notion of “low” seems to vary a great deal with doctors, as you’ll see when you read those comments. (Note: low often means 10 mg / day or less and very low means 5 mg / day or less.)

Long term high dose: I’ve never seen this practice advocated in an academic journal or by a university hospital. There is no way to prove how common this is, but I’ve personally heard from many patients who have lived it. How high is high? How long is long? It’s subjective, of course. But, I’ll tell you what my personal rheum doctor said when I mentioned some of the doses that I’ve heard. Doc joked, “Are those rheumatologists in jail?”

Early low-dose prednisone for Rheumatoid Arthritis

There is a lot of talk about treating Rheumatoid Arthritis early with disease modifying anti-rheumatic drugs (DMARDs). In recent years, there have even been numerous studies on very early treatment in attempts to find the pot of gold at the end of the rainbow a way to bring remission to more patients. Some researchers have shown that the use of low-dose steroids early in the disease increases the rate of remissions and improves clinical status. In the next post in this series, we’ll look closer at the use of low-dose prednisone in early Rheumatoid Arthritis.

Recommended reading:

Footnotes Many articles provided background for this series; however the following were particularly helpful: Journal of Rheumatology  * Interscience Wiley * British Medical Journal

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Kelly Young. All rights reserved.

This entry was posted on Thursday, May 27th, 2010 at 7:07 am 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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