Arthritis and Prednisone

Question

I have been taking Prednisone for the past 10 1/2 years for (Juvenile)Systemic Rheumatoid Arthritis. The average dose has been 20mg daily. I recently (over the past 6 months) had gotten the dose down to 15mg (the least I have EVER been on). I had been experiencing stiffness in the mornings, but was able to manage the pain throughout the day. Last week, the pain became so great that I increased the prednisone dose to 20mg. This did not help. Today, I increased it to 25mg. Because of the prednisone usage, I have to monitor my blood sugars and take insulin daily. I called my rheumatologist and he said that he didn’t know what else he could do for me. I know Prednisone is killing my skeleton – the bone denisity reports tell me that. But when I try to get off of it, I have a relapse and have to take more of it! I have tried all kinds of other drugs; I take Arava, Ultram, and Apsirin daily. I have tried Methotrexate, Enbrel, but neither worked. In fact, these drugs seemed to make the pain worse (I had a lot of swelling and joint pain). I currently take 2 fluid pills for the swelling in my legs and ankles, but the swelling doesn’t seem to go down. I’m only 26 years old — what can be done to help me?????

Answer

I agree that taking prednisone at those doses over a long time can cause serious, even life threatening side effects. Every attempt needs to be done to get you on a lower prednisone dose. You need to carefully review which medications you have been on and make sure that you indeed did not respond to them. Combinations of medications frequently are helpful even when the medications were not helpful by themselves. Finally, you might want to be evaluated at a University center with access to the newer treatments– new biologic agents are being evaluated at an increasing rate. Good luck.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University