Can prednisone side effects occur even with low doses?
This is the third post in a series about approaches to the use of prednisone for Rheumatoid Arthritis. Please read the first post, Prednisone Dosage for Rheumatoid Arthritis, here at this link. Do prednisone side effects occur even at lower dosages? How quickly do they occur? Do doctors and patients find it so effective that prednisone side effects are worth the risk?
Note: these are very brief excerpts. The linked original articles also include numerous footnotes.
- The British Medical Journal report describes the reassessment of prednisone that “began during the 1980s, based on recognition of severe long-term outcomes of RA and clinical experience indicating relatively limited toxicity associated with low doses of glucocorticoids (like prednisone) … Reports indicating disease modification even with low doses of prednisone or prednisolone of 5–7.5 mg/day are of particular interest, as doses of 10 mg/day are associated with adverse outcomes including bone loss and higher mortality rates… Long-term safety remains of concern. Higher mortality rates have been associated with the use of prednisone in an earlier cohort of patients seen by the senior author at Vanderbilt University and by others.”
- According to the Journal of Rheumatology article, “Recent reports of longterm prednisone use suggest that even exposures of less than 5 mg a day may be associated with potentially severe outcomes.” Surprising: “Retrospective observational studies, however, suggest that excess adverse events (e.g., fractures) are present after as few as 3 months.”
- A study described in Musculoskeletal Report of doses of prednisone less than 5 mg /day found they were associated with an increased risk of pneumonia. “After adjustment for covariates, prednisone use conferred a 70% increased risk of pneumonia hospitalization.”
- One study reported in Arthritis Research & Therapy suggests a possible “catch 22” with prednisone effects. As I mentioned in part 2 of this series, prednisone may slow bone erosions in early RA as long as its use is continued. “We suggest that glucocorticoids may protect against the negative effects on bone primarily caused by the rheumatoid disease, a suggestion supported by the rapid decrease in 1CTP in the P-group.” The catch? Prednisone can suppress bone synthesis, leading to bone loss. “On the other hand, the systemic inflammatory consequences on bone could not be prevented because of suppression of bone synthesis. Bone loss in the spine was more pronounced in postmenopausal women treated with glucocorticoids.”
Sound frightening? These quotes are from the same group of articles which I read exploring the importance of the use of the long term low dose prednisone. I did not go find articles against the use of prednisone that paint the worst possible picture for the purpose of scaring patients – I’m sure those statements are out there. It is interesting that some comparable lists of side effects tend to be less frightening perhaps because the drugs are so familiar – such as birth control pills.
Have you experienced prednisone side effects?
The prednisone side effects page at Drugs.com says the most common are “difficulty sleeping; feeling of a whirling motion; increased appetite; increased sweating; indigestion; mood changes; nervousness.” Scroll down that page to “for the Professional” and see the exhaustive list. Which prednisone side effects have you experienced?
- Prednisone Dosage for Rheumatoid Arthritis
- Low-dose Prednisone in Early Rheumatoid Arthritis
- Prednisone and Rheumatoid Arthritis
- Comparing Risks and Benefits of Rheumatoid Arthritis Medicines