Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
I am one of the fortunate people who have no (immediate, at least) side effects from taking prednisone. At my recent checkup, I mentioned that I felt I'd been experiencing more pain / inflammation than previously. We discussed switching biologics in three months, and my rh suggested a course of steroids in the meantime. I am already taking meloxicam, and methotrexate, and my current biologic, for reference, is Stelara.
So, six days, carefully following the directions, and yay, a fairly significant decrease in perceived inflammation, a fairly significant decrease in perceived pain, a small increase in flexibility. Certainly I was able to stretch / exercise more thanks to those changes, and that was also helpful.
But now, a week after the last dose, I can tell that my hands are starting to stiffen up again.
So here's my question: what purpose did the course of steroids serve? It did show me the level of consistent inflammation in my body, and it was definitely a relief to have that lessened for a short time. But even though I don't have obvious side effects from the prednisone, it is not - am I right? - something you take long term.
I know it's impossible to answer the real question here, which is this: is the payoff worth the risk? On the surface, it seems that putting yet more meds into my body for just ten days or so of reduced pain isn't really worth it, pleasant though those ten days were. And it's premature to say that I'll return to the pre-prednisone pain and infmallation levels, although I sense that I'm creeping back in that direction. And I guess there's no way to assess the benefit to having that inflammation out of my body even for a short time - surely that's of some benefit to my entire health, but how to assess it? (My blood sugar and blood pressure remained consistently unremarkable the whole time, and my weight stayed the same.)
Has anyone taken steroids, presumably in a reduced dosage, over a long period of time? A quick online check shows that such a thing is possible. I'm wondering if anyone here has found it helpful.
I just feel that the experience has given me some more information, but i'm not entirely sure where to go with it.
Prednisone inhibits collagen production. Many think so what. I can deal with sagging skin, but it's way more than that. Healing becomes a snails pace. Bruising is a very, very common issue. Your tendons loose elasticity (can we say trigger finger anyone?). Even your veins become more brittle - thus more bruising. You can imagine there really isn't a surgeon who wants to operate on you.
In addition even though your sugar levels are fine on a short course increased length of use does increase the chances of becoming a diabetic. As I am already a type one I can definitely tell you, you are running your kidneys in overdrive while on it as even though your sugar levels are fine they are working double time to accomplish it.
My skin is also becoming very thin. You can basically see all my veins even with a tan. It is easy to tear my skin. My dogs wear nail caps and they still end up ripping me up. And those rips don't heal! Everything becomes so brittle.
I have been on a 5mg daily dose for 4 years now. I am only on it as I have indeed tried all but one of the RA drugs to treat RA including the infused and have failed them. The one I haven't tried yet is Rinvoq but as it's fairly similar to the way Xeljanz works I'm not holding my breath it will help.
My bone density did show it had decreased from last year which can be attributed to prednisone use but we are saying it has more to do with my age so that I am 'allowed' to stay on it as I am completely disabled (as bring out the bed pan and outside help) without it.
I have notable muscle wasting from it as well in spite of increase resistance training (and a days worth of pain from training is now more like three as it takes longer to repair those torn muscles - sigh) and yes my hair has completely thinned out as it became brittle around the third year of use. I suppose it's because it took that long to grow out a shaft of hair that didn't have that lovely collagen in it to keep it healthy.
Prednisone does make you feel mobile and more awake, but it does zippo for preventing damage. My hand x-rays testify to that. The damage was really bad the first three years that I was diagnosed and then while I was on Xeljanz and then Rituxan it hadn't changed for about 7 years and now that I am only on Plaquenil and steroids erosions are showing up as if mice are at an all you can eat cheese buffet.
So yes, short term it isn't too bad and those few days of less pain to help you recharge and tackle life are good, but long term it's effects do add up and eventually begin to show.
A long, long time ago, on this very website several of us dubbed pred the "drug we love to hate" men aing that all of us had a love/hate relationship with it.
Pros are: increased energy, feelings of euphoria or overall wellness. (Honestly it would be my “drug of choice” if not for the downsides).
Cons are: Moonface for some, insomnia for many, and the effects described above by smith. Hard to say for sure, but I blame it for my osteoporosis (in addition to aging). It may in fact have contributed to all-over aging sooner and more severely than I had I not ever taken it. BUT...when I did take it, it was a quality of life decision. I too it when other meds failed or I had to go of them for surgery, etc. and the pain was unlivable.
I have loads of side effects from it. Weight gain, mood swings, cataracts, adrenal failure, decreasing bone density, and it attacked my heart giving me CAD.
I confess I have no answer to your question of why put you on it for short term use. Certainly, it did help with pain, stiffness and flares, but everything goes right back to the way it was when you go off. If he was keeping you on it till a new drug worked, it would be one thing. But just for a random amount of time makes no sense.
I would be much more interested in getting you on a new biologic. When I was transitioning to Rituxan, I was up to 15 mg in the first month. As it started working, I cut down the dose. But then I had trouble getting off the last mg. That was either real addiction or psychological addiction. 2 years ago, my bone density hit osteoporosis. I had been on low dose prednisone a long time. So, I kicked the addiction, and decided not to take it again. A year later, I got a Kenalog shot in my bad knee. I didn't realize it was cortisone. It didn't last long. I went into adrenal failure by the second month. I was just exhausted. I talked it over with my rheumatologist, he agreed with me I should take opioids, rather than prednisone. I just reached over a year not taking it.
I doubt I will ever take it again. Everyone needs to decide for themselves after talking with their doctor about whether continuing to use this very dangerous drug.
@WG. I remember when we used to say that. I still remind myself if that, from time to time! It's still true!
Me! Two years, and 2 nights ago I went on prednisone. The pain was the worst I I have ever had, although I had some mobility in a stiff sort of way.
I took 15 mg the first day, I'm straying on 10 mg, which is not quite enough, but I don't want those side affects crashing into me! I swore I would not take it, but when push came to
Pain, that was the only answer. Before I was diagnosed with RA, because of being sero-negative, but with massive symptoms, an internal medicine doctor put me in 15 mg of prednisone but nothing else for 1 1/2 years. It helped a bit, but the deformities progressed, as prednisone does. I've been on high doses for asthma, 40-50 mg daily for 5 days, 20 mg a day when my meds failed, and we had issues getting a biologic to work.
I know it has given me cataracts, heart disease, osteoporosis, mood swings, weight gain, etc. Right now I'm kind of silly & giddy, not the normal me.
I begged my doctor to let me go back on mthx, and he would not. My liver specialist said I could stay on mthx as long as my ALT wasn't over 100. Well, it was 99. Most likely from antihistamines I had been taking to cope with the forest fire smoke. Anyway, he may fire me as a patient, but he is getting an ear-full.
My hope is that the mthx will
Pick up and go back to like it was before I stopped it. 8 days to take mthx, then I can wean off the prednisone, before it damages me more than it helps!