Prednisone, how much is too much

Question

Currently I am on 20mg of Methotrexate a week, 2 pills a day of 200mg celebrex and 7.5mg prednisone a day plus 2ultram twice a day for pain. I was told i had one of the worst cases of RA. I am 33 years old and have so many years to come on medications and was wondering…. 1) How much prednisone is ok to take daily if I needed to for years to come? 2) How much Methotrexate do they give you before they stop upping the dose? 20mg, 25mg etc. per wk. 3) I heard methotrexate stops working for some people in time after a couple years, does this happen a lot? 4) Last, I have read some articles on promising cure like shots etc. that are about to enter human testing, do you think such cures like at companies like Garvan Institute might really happen? I know this is a lot of questions, but every time i try to bring things up to the Rhummy docs I see, they just seem to want to rush you out to the next patient.

Answer

Let see if I can work through some of your questions:

1. There is no “safe” dose of prednisone. Prednisone over time increases the risk of cardiovascular disease, osteoporosis and infection. It can worsen underlying diabetes and HTN. The effects are dose related– higher the dose, the worse the side effects. Prednisone use should be minimized. A dose of 5 mg daily use to be considered acceptable, but current thoughts are to try to eliminate completely, particularly if you are prone to develop the conditions I mentioned above.

2. methotrexate is used up to 20-25 mg weekly depending on the patients.

3. For some, methotrexate does appear to lose effect, but this is not universally true. In studies, about 40% of patients discontinue methotrexate by 5 years.

4. Yes, there are a lot of new biologic drugs for RA that are very effective. Look on this website.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University