Hi Kathy,

Sorry you're suffering like you are. When did you start your 60-30 mg taper?

There must be a reason you're not on MTX, as well (pls forgive me if you said why in another post), since that's pretty standard treatment. Be that as it may, I'm not sure there's anything that will suppress inflammation, and pain from inflammation, as quickly as prednisone will.

You're going to talk to your RD tomorrow right? If you're still feeling ragged on your current dose of prednisone tomorrow, then tell your doc, and ask about maybe adjusting a maintenance dose. I'm not sure what high dose means to you, but maintenance dose for me was 20 mg.

Here's my experience: I was taking 20 mg prednisone, 75 mg oxycontin and 3x600 mg ibuprofen when I started Rituxan. I was hurting a lot, and not getting anywhere. I just now looked at my records and was reminded that I did start to taper the prednisone right away, and I also began to wean myself from the pain meds. By mid June, I was down to 10 mg prednisone, 40 mg oxycontin and ibuprofen twice a day. My doc prescribed sulfaslazine, but I had some bad side effects and stopped it after 10 days, but that was about the time Rituxan kicked in. I kept tapering, and reducing my other meds, even during the gap before the 2nd treatment kicked in, but my activity levels had dropped and I was in a lot of pain. In early December, I was at 2.5 mg prednisone, 20 mg oxycontin and ibuprofen about once a week. However, I called my doc, got him to OK going up to 10 mg prednisone. Two weeks later, the Rituxan kicked in again, and it's been good since. I was done with prednisone and pain meds in Marc, 2009, and I take ibuprofen once or twice a week now.

I know waiting is tough, especially when you're still in bad pain, but call your doc and work out a plan. I wish I could tell you everything you want to hear, but mostly, I hope that what you wish happens quickly.

It stinks that you didn't have a better idea of what your to expect BEFORE you had your treatment. I'm a firm believer in advocating strongly for your needs, and that includes knowing what to expect from diseases, from drugs and other treatments. We all need to make sure our questions get answered.

Good luck with this, and please let me know what your doc says and how your doing.

doug

Hi peppyest,

I hope your Rheumy has some good instruction about your med's so that you can function & move again soon. Sorry that this rotten RA beast is treating you so unkindly!

I checked your profile but that doesn't have much info so will try to provide some helpful comments. I assume that you've had RA for a while if u r already starting biologic.

I thought Prednisone would be used until Rituxan starts working. Some people have other health problems precluding them from being on Pred but it's a good short term fix for a flare. The reduction from 60 to 30 seems quick, speak to your Rheumy. Rheumys need to remember that we have to function & deal with all our responsibilities too.

I was on Pred 60mg initially due to pneumonia when I was also being dx with RA. I stayed on high Pred dose of 40mg then to 30, 20. I have been tapering from this high dose for 2 years & now down to 4mg. I am on MTX & Celebrex also. Obviously I have had to deal with Pred side-effects of insomnia, Cushingoids etc but I need to function & now when I taper by 0.5mg each month I have a week of rebound inflammation (increased pain in most joints) BUT I am nearly down to the 2 or 3mg maintenance dose that I will probably need long-term.

Keep us posted & welcome to DS!

Take care, Anna

Doug,I've tried MTX several timees and can't seem to tolerate
but I'm going to try again out of sheer desperation...I 'm usually
never higher than 15-20 on prednsione over the last year BUT
this "episode".if you will is like nothing i've ever experienced.
Also,of significance.1 mth ago I weaned myself off fentanyl patches
I'm down to 12 mcg which is almost nothing.So I take nothing but
OTC pain meds=translation=no relief.I'm trying to figure out your
time frame from starting rituxan and tapering down on meds...
looks like june to march.When did you first start noticing a difference from the rituxan.Did you do first dose ,second dose a wk later and then when was the third dose?...Noone gave me any
firm timeframes for the rituxan...Doug , you are extremely helpful.
are you a health care professional too?Hope I didn't bug you with too many ??Take good care,Kathy

Kathy,

I have been a massage practioner, but Inot professionally since 1996. And, you could never bug me with too many questions.

My time frame was start of Rituxan on April 8, 2008, 2nd infusion on Aptil 22, and start of really good results from Rituxan in the latter part of June. I began to feel something better before that, but I can't recall precisely, so I've dopped that from my timeline, and my stock reply is 2 months.

I've always had a 2 week interval between 1st and 2nd infusions in the 5 treatments I've had, to date. For the most part, it'd been 6 months between greatments, although I went 8 months between October, 2008 and June, 2009.

I stayed on prescription pain meds and prednisone until March, 2009, although I was tapering all the while. It was December 17, 2008, about 7 weeks after my 2nd Rituxan treatment that the green light came on. Although I had had about 3 1/2 months of excellent relief before, it was about 8 months before I reached the point I'm at now. I don't want to, in any way, suggest that my experience is the norm, but since Dec 17, 2008, I've had no RA symptoms, save a 4 day flare after Thanksgiving, 2009.

I can only say that this is my experience. I can't say enough about how wonderful this drug has been for me, but I temper that with the knowledge that everyone's experience is different from another's, and this is not a drug to be yaken lightly.

I wish youthe very best, and I'm always available for any questions you may have (except, I'll be gone for most of the next 3 weeks).

Blessings,
doug

Doug,Hope I catch you to say thanks before you leave for 3 wks...
Interesting that were a massage therapist ...me too.While practicing
RN in my 23 rd yr I went to massage school,graduated and was hit
with RA and could never practice massage...May I ask when you'll be
back on the board...you're a lifesaver.

Hi Kathy,

By now you will probably have a chance to talk to your Rheumy and, hopefully, can sort out the Prednisone dosage. It does seem to be a very quick reduction. I have been on Prednisone since Jan, 2010 and my Rheumy has had me tapering very slowly, as in three weeks for each 1 mg. Because of bad flares, I've had to go higher at various times and then taper back to where I was.
I hope your Rheumy will help you with the pain and swelling and you'll be feeling much better soon.