This is the fourth post in a series about modern approaches to prednisone uses for Rheumatoid Arthritis. Please read the first post, Prednisone Dosage for Rheumatoid Arthritis, here at this link. Does prednisone have a disease modifying effect? Is it a double-edged sword? What’s the greatest risk of prednisone use that you may not have heard of?
Prednisone use with a DMARD
Experts disagree about whether prednisone can be considered a disease modifying drug. Large studies of long term low dose prednisone use have not yet been conducted so risks and benefits cannot be clearly measured, but for most patients prednisone use dramatically reduces symptoms of Rheumatoid Arthritis.
Prednisone has been shown in smaller studies to reduce bone erosions in early Rheumatoid Arthritis for some patients as long as its use is continued and as long as it is combined with another disease modifying antirheumatic drug (DMARD). “Because of their limited disease-modifying effects, glucocorticoids should be combined with disease-modifying antirheumatic drugs in patients with rheumatoid arthritis,” Annals of Internal Medicine.
One problem with prednisone uses for RA
Unfortunately the effectiveness of prednisone at suppressing Rheumatoid Arthritis symptoms can also work against the RA patient. Beginning DMARD treatment is often a difficult decision and prednisone could make it more difficult.
“The immediate clinical benefit of oral glucocorticoids, regrettably, could represent a double-edged sword: patients and their physicians may now believe that their improved status no longer warrants remittive therapy. A recent study supports this phenomenon, reporting that among patients followed consistently by rheumatologists but who were not taking DMARD, 37% received oral steroids. Similarly, it has been stated (without clear published evidence) that the immediate gratification afforded by steroids may make it difficult to discontinue them.”
Where do we stand with prednisone for use Rheumatoid Arthritis?
Some of things seem clear with this four part series on prednisone.
- Doctors do not all use prednisone in the same way to treat Rheumatoid Arthritis.
- Modern studies show earlier, lower doses of prednisone combined with DMARDs may be beneficial to slowing disease progression as well as gaining control of RA symptoms.
- Prednisone side effects may occur quickly in some patients or not at all in some others. Most are somewhere in between.
- Relying upon prednisone can lead to delay of treatments meant to bring remission (DMARDs).
- Prednisone Dosage for Rheumatoid Arthritis
- 3 Reasons to Stop Saying “Complications of Rheumatoid Arthritis”
- My Journey with Rheumatoid Arthritis Medicine
- Rheumatoid Arthritis Swelling: My Confession