What you need to know about prednisone for rheumatoid arthritis

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There are several benefits, interactions, and warnings to be aware of when taking prednisone. Prednisone is a potent, short-acting oral corticosteroid that is generally prescribed short-term in low doses to relieve pain and inflammation in the treatment of rheumatoid arthritis (RA) and other inflammatory conditions.

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Applications

Inflammation is the immune system's response to anything it deems harmful, such as injury or infection. In RA, the immune system mistakenly attacks healthy joints, usually causing pain and swelling .

Prednisone reduces inflammation by stimulating glucocorticoid receptors in cells, causing the suppression of cytokines (proteins that mediate between cells).

The recommended first-line treatment for RA is disease-modifying antirheumatic drugs (DMARDs) , but these drugs can take 8-12 weeks to take effect. Prednisone is often used as a "stopgap therapy" to alleviate the condition before DMARDs take effect.

Prednisone is a short-acting drug that quickly relieves inflammation, but its long-term use is not recommended.

Prednisone usually takes about an hour to work and stays in the body for about a day. Repeated doses should provide noticeable relief from arthritis flare within 24 to 48 hours .

The downside of prednisone: Unlike DMARDs, it doesn't target a specific biological or cellular function. Instead, it works systemically, filling the body and affecting many different cell types and functions.

So while prednisone provides quick relief, it has a number of side effects that limit its use, especially over long periods of time .

Other use

In addition to treating RA and other types of arthritis, prednisone is commonly prescribed to treat :

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Prednisone is generally prescribed to treat joint pain and inflammation even before a formal diagnosis is made.

Reaching a diagnosis of RA can be difficult and take some time, as other conditions need to be ruled out . Prednisone can help relieve symptoms until this process is complete. Since the drug can be beneficial for a variety of inflammatory conditions, it can be beneficial even if you end up without RA.

Corticosteroids, such as prednisone and its chemical cousin prednisolone, are often used as a test before diagnosis to differentiate between RA and osteoarthritis (OA) . A 2017 study published in the journal Arthritis Research and Therapy reported that a 40% pain reduction on the third day of the prednisolone study (preliminary test) was a key indicator of RA versus OA.

Talk to your doctor about all the medications, supplements, and vitamins that you are currently taking. While some medications pose little risk of interactions with prednisone, others may directly contraindicate their use or prompt careful consideration of whether the benefits of treatment outweigh the disadvantages in your case.

Precautions and contraindications.

Before prescribing prednisone, your healthcare provider will weigh the risks and benefits in your specific situation. Certain health conditions increase the risk of side effects when taking prednisone. Be sure to tell your doctor if you have any of the following:

Women who are pregnant or who may become pregnant should consider the potential risks that prednisone may pose to the fetus. Prednisone use during pregnancy has been associated with cleft palate , preterm labor and low birth weight in infants, and pre-eclampsia and gestational diabetes in mothers.

Prednisone is contraindicated in people who are allergic to prednisone or an inactive ingredient in the drug. Tell your doctor if you have had any unusual or allergic reaction to this or any medicine.

Dose

Prednisone is available in immediate-release and delayed-release forms that are taken by mouth.

The usual dose of prednisone is 5 to 10 mg per day. People with RA who have extra-articular symptoms, such as inflammation of the eyes or lungs, are more likely to receive higher doses of prednisone, which can go up to 60 mg / day.

For the treatment of RA in adults, the drug is prescribed as follows:

  • Immediate-release prednisone is given in a daily dose of less than 10 mg per day, taken with DMARD.
  • Delayed-release prednisone is given in a dose starting at 5 mg per day, followed by the lowest possible maintenance dose to maintain good clinical outcome.

Prednisone is usually taken in the morning (when you are most active, depending on your circadian rhythm ) and with meals (to prevent an upset stomach).

For people with severe RA, the delayed-release drug can be taken before bed to reduce morning stiffness and pain .

The duration of treatment is selected individually. And you can get a prescription for daily or intermittent treatments.

Prednisone is also approved for use in children ; a pediatrician or rheumatologist can determine the correct dose based on the child's condition and age.

Side effects

Side effects of prednisone can range from mild to severe, depending on the strength of the dose, the duration of the dose, and your individual response to it. They occur more often at higher doses or with prolonged use.

general

Short-term side effects are similar to those of other corticosteroid medications and can include:

  • Fluid retention
  • Upset gastrointestinal tract (abdominal pain, diarrhea)
  • Elevated blood glucose

Severe form

However, more serious problems arise when treatment is continued for longer periods of time, often with increasing intensity as the duration or dose increases.

These effects can include:

Warnings and interactions

Prednisone is known to have many drug interactions. In some cases, a secondary drug can increase the bioavailability or absorption of prednisone and, as a consequence, the severity of side effects. In other cases, prednisone can interfere with the effect of the secondary drug.

Notable interactions include:

  • Antibiotics such as clarithromycin or rifampin.
  • Antidepressants such as Prozac (fluoxetine) and Zoloft (sertraline)
  • Anticonvulsants such as carbamazepine and phenytoin.
  • Antifungal medications such as Diflucan (fluconazole) and Sporanox (itraconazole).
  • Anti-nausea medications such as Emend (aprepitant)
  • Asthma medications such as Accolate (zafirlukast)
  • Aspirin
  • Blood thinners such as Coumadin (warfarin)
  • Diuretics (tablets for urination)
  • Heart medications such as amiodarone , diltiazem, and verapamil.
  • Heartburn medications such as tagamet (cimetidine)
  • HIV drugs such as Crixivan (indinavir), Kaletra (lopinavir / ritonavir), and Reyataz (atazanavir)
  • Hormonal contraceptives
  • Immunosuppressants
  • Other corticosteroids
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Combining NSAIDs with prednisone can increase the risk of developing peptic ulcer disease, which can cause bleeding and lead to hospitalization.

High doses or long-term use of prednisone can lower the immune response to certain vaccines and make them less effective. Also, if you have received intensive prednisone treatment, you should wait at least three months after stopping the vaccination before administering the live vaccine, as the steroid may increase your susceptibility to infection.

Termination of use

If you have been taking prednisone for a while, you should not suddenly stop treatment. The adrenal glands usually produce natural amounts of cortisol (a steroid hormone) every day, but this production is reduced if you have been taking prednisone for a period of time.

Slowly reducing the dose of the drug can help you avoid or minimize the side effects caused by abruptly stopping treatment. Withdrawal symptoms can include extreme fatigue, weakness, body aches, and joint pain.

The gradual tapering of prednisone is an attempt to "wake up" the adrenal glands so they can start doing their job again.

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