Tuesday, July 27, 2010 V, Health Guide, asks

Q: What is the safest effective dose of daily prednisone?

I had an asthma attack last week and have been taking prednisone since then tapering off to 20 mg by this Thursday.  I see the doctor again Thursday and I don't know if I will have to continue taking more prednisone or not.  BUT, through this asthma attack thing, I have learned how much prednisone helps w/the arthritis pain. It has been aboslutely eye opening. I know prednisone is hard on your body and has many side effects. I was wondering if 5 mg a day would be a safe dosage that might help w/the pain and inflammation of arthritis. I haven't been so pain free in years, but I know I can't take the amount of pred the doctor prescribed for this asthma thing.  I took 60 mg for 3 days, 40 mg for two days and 20 mg for two days.  I must say it has been a welcome respite from the daily arthritis pain grind. Thanks for any info anyone has. V

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Answers (2)
Lene Andersen, Health Guide
7/27/10 12:07pm

Unfortunately, this is one of those questions that should be answered by a medical expert - not only does an adequate dose of prednisone (or any medication) vary from person to person, but I'm simply not qualified to say.

What I can tell you, though, is that many rheumatologists will prescribe a dose of prednisone along with other DMARDs (methotrexate, Plaquenil, the Biologics). This one varies from doctor to doctor, as well. Some won't give you any prednisone at all, except in emergencies or control the flair and the others consider it a safe practice to include it as part of your regular meds. Prednisone can give it a wonderful boost to meds and to your well-being in general, but like any other medications, you have to consider the pros and cons, risks and benefits and what you can do to manage those risks (e.g., we'll have a post up tomorrow about osteoporosis).

 

Have a conversation with your doctor about this. The main issue is that through getting prednisone for your asthma attack, you've discovered that the medications you are currently taking are not managing your RA and/or pain levels properly. Does that mean you should consider prednisone on regular basis? Maybe. However, it may also mean that you and your doctor me to take a look at your current medications and whether you need to increase the dose, add another of the DMARDs or switch altogether. It may also mean that you are not getting adequate pain control, so if your rheumatologist is not comfortable prescribing pain meds - and many aren't, although I cannot imagine why, as they specialize in a disease that comes with chronic pain, but that's a rant for another day - where was I? Oh yes, ask for a referral to a pain specialist.

 

Please let us know how it goes?

 

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V, Health Guide
7/27/10 9:53pm

Thanks, Lene. I know prednisone has a lot of side effects, and I already have osteopenia.  At least I did two years ago. It's just that I feel good for the first time in years, even w/the asthma not completely cleared up. I have energy and my hands, feet, hips, shoulders and neck do NOT hurt.  I am just so amazed by this.  The rheumy gave me Tramadol but I haven't taken it. My GP said it wouldn't make me feel too well and to only take it if I really had to take it. I can only take celebrex once in a while, and it does help, but only takes the edge off.  It fights my bp medicine and my bp starts inching up after a few days. I thought the prednisone would do that, too, as it has in the past, but I'm doing well with it. I am down to 20 mg tomorrow and Thursday and then I will be out of pred. I see my GP on Thursday afternoon. She might prescribe a lower dose for another week because I still have some wheezing, but I am much, much better. I have an albuterol inhaler, too that is working wonders.  Could the inflammation I have from the arthritis, cause my asthma to flare, too?  I know I should ask the doctor, and I will.   It is just more comfortable talking to someone who knows what it is like.  You are such an inspiration. I don't mean to compare myself to you.  My symptoms are very mild compared to yours.   I just have a lot of respect for your perserverance and positive attitude.  Thanks for being here.  Have a good evening.

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Lene Andersen, Health Guide
7/28/10 10:59am

Given that you have had osteopenia, your doctor may be leery of giving you prednisone on a regular basis. However, if you get a bone density scan and it shows that your bones are doing well and continue to get bone density scans on a regular basis to keep an eye on any possible developments in that area, it may be possible.

 

In terms of the asthma and RA flares being connected, it's possible. You may want to keep a symptom diary for while where you write down how you're feeling, what medications you take, weather, food, etc. - it can help you identify patterns. You may not need to be very detailed about it and if it sounds like too much work, maybe just make a mental note to pay attention to how your asthma is doing on days when you're RA is bad. It may not have any treatment implications, but it could help you manage better. And yes, definitely ask your doctor. They may not know, but it doesn't hurt to ask.

 

I'm not a big fan of making comparisons - as I tend to say, compared to a child starving to death in Darfur, we are all doing very well. Your symptoms are valid within your own experience and just because I've had this disease longer or perhaps have a more severe case doesn't mean you don't get to express your feelings about having a hard time. We all learn from each other and although a rheumatologist is essential in terms of the treatment part, learning how to live with it comes from within yourself and from talking to other people who have RA. If there's anything I've learned from working on theis site, it's that regardless of how mild or severe your disease is, we all have remarkably similar feelings about it.this one of the great things about sites like this - you realize that you're not alone and that there are a lot of people out there who know what you're going throughand more willing to support you through it.

 

Keep us posted on how things go, please?

 

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Angela53510, Community Member
7/27/10 11:46pm

Yes - I went through a similar thing - I had to take prednisone for a bad asthma attack, and realized how much pain and suffering I was undergoing with the RA.  That is when I started demanding help and went on disability.  It took a long time to get the right med mix, 6 years, actually, and I will tell you what I think about the safe dose for prednisone is - 0 mg.  

 

Besides the weight gain, what it did to my moods, I have a cousin who has been on it for 56 years.  Only 5 mg - I don't think you can get lower than that.  She had 3 vertebrae dissolve in her neck, and had to get a metal plate put in so her head would be supported.  That was 6 long months in a halo.  The sad part - is she has huge deformities, multiple joint replacements, and they gave it to her when she was young, and she is a dwarf.

 

I agree that if you are in pain, you need a DMARD, and if that isn't enough, try a biologic.  I got my life back, mostly (except for the deformities) when I got on my biologic.  I rarely have flares, and I can exercise, and do most of the things I want.  Unless you have extremely mild RA, you really need to consider getting meds which don't just cover up inflammation, but actually stop it.  I was on 15 mg of prednisone for over a year as my only med, because that is the help I was offered. I was completely miserable.  A pain specialist only wanted to give me more drugs, which upset my stomach, which was damaged by the prednisone. Kind of a vicious cycle.

 

Just my experiential, although not professional opinion.

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V, Health Guide
7/28/10 6:31am

Thank you for sharing your experience, Angela.  I know you are right.  I know what my GP thinks of prednisone, too, and she wouldn't have given it to me if she had any other option.  The asthma attack was pretty bad. It was my fault, really. I know I have bad allergies, but I take so many pills, I just sort of laid off the antihistimines because I was tired of pills, pills, pills.  The rheumy diagnosed me w/inflammatory osteoarthritis, but it may be RA or it may turn into RA from what I have been told and what I have read.  I also have high bp, prediabetes, plain old osteoarthritis, fibromyalgia and asthma. I take Plaquenil and it helps a lot but I am still in pain every day. I'm not quite sure what to do or what to ask for.  I take Lexapro for the fibro because the meds formulated specifially for fibro make my bp go up. Ai Yi Yi............may I ask what meds helped you the most w/everday pain?  Do you take Plaqeunil, too?  Thanks so much for your insight.  Getting input from others helps me figure out what I need to ask the doctor.  Sometimes doctors can be intimdating! LOL  V

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Angela53510, Community Member
7/28/10 4:25pm

I take Sulfasalazine for RA (I used to take methotrexate for a DMARD, a much better drug, but it damaged my liver badly, after 10 years on it.) I also take Kineret, a biologic, which has helped me the most.  

 

I tried Plaquenil in the beginning, but it did nothing for me.  I also have a lot of conditions.  I think for lungs and asthma, if you don't keep it under control, prednisone is sometimes the only option. But for RA, there are better things. I also did allergy shots for 7 years, which really helped take me from severe asthma to mild.

 

I do not take pain killers anymore.  They gave me migraines, because my stomach was such a mess from the anti-biotics, the prednisone and the oral methotrexate (I switched to injectable, eventually). I can honestly say I don't really need them, because the flares are under control. I also have high blood pressure, probably associated with the RA, is the only explanation I can get from the doctors.  Inflammation of the circulatory system.  I always had low blood pressure, along with the rest of my family. I might have fibro, but I am trying very hard to ignore it, in the hopes it will go away.  I really would ask for a better meds for you RA.  You may be sed negative too.  That is what made me hard to diagnose. 30% of all people are.  We get treated like it is not a big deal, but I was crippled and in a wheel chair, before I found a rheumy who diagnosed me based on symptoms, not numbers. He figured if the drugs worked, it was RA, and he was right.

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KC06062006, Community Member
11/25/10 1:44pm

I really feel for you. I have been diagnosed with a form of spondularthropathy and fibromyalga. I do not have any breathing problems. In fact, until six years ago I was a healthy, successful, functional person.  Now I am in constant, severe, pain. I use pain medications but my body becomes used to the drugs and stops working so I have to switch it up. I was given Prednisone for two months about four years ago and everything was better. Not a little but completely.  I lost weight as I could be active. I was pain free and had energy.  I have convinced my doctor to put me back on Prednisone twice over the past three years and for two to three months I was a normal, functional, person. I understand that long term use is bad but so is not getting out of bed and crying myself to sleep at night. I am close to losing my job as I simply cannot function.  So if methotrextate damages your liver and causes other problems, why is Prednisone so evil? The new treatments for RA and related conditions are just that - new.  So in 100 years are they going to be in the same classification as Prednisone as more damaging than good?  I am so thankful this person posted this blog. It makes me feel like I am not alone.

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V, Health Guide
11/26/10 12:40am

Hi, KC. Sounds like your doctors do not have your pain under control at all. For some reason, I fought taking pain meds since they were first prescribed for me. I have never liked taking pills and my NP was always telling me not to take any medicine unless I absolutely have to. But...I finally gave in. I knew today would be a busy one and I wanted to cook a nice meal for my family, so I took Ultram last night and I had a good day today.  It didn't take away all of the pain, but it did enough that I could rest well last night and function well this morning. I took another one this afternoon.  What it has shown me is that I was totally unaware of just how much pain I was in.  My ortho and my Rheumy want me to take 3 pills a day. I don't think I want to take that much, but we shall see.  Ultram doesn't work like prednisone does, but it does definitely take the edge off the pain.  I have always been worried about liver and/or kidney damage from medication. My doc orders blood tests every six months because I also take Lipitor and bp meds, etc.  I guess it won't hurt to take the Ultram from time to time.  Have you ever tried the biologics?  I feel for you. You need some help from your doctors so that you don't have to fight your way through the pain every moment of every day. Surely they could try a new combo of drugs or something.  Best Wishes to you, KC.  Peace, V

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By V, Health Guide— Last Modified: 03/11/14, First Published: 07/27/10