RA & Prednisone: What is Right For You?

Patient Expert

The use of prednisone is a topic that is highly charged in some circles. My point of view is that we all need to weigh the pros and cons of using steroids in light of our own individual circumstances.

Prednisone was the first medication that gave me relief from the unrelenting pain that was making my life a nightmare. It was prescribed by my orthopedic doctor while I was waiting to get in to see a rheumatologist. That was in March of 2010. I have not been completely off of prednisone since.

I know several people who cannot take prednisone because of other health issues, and I feel for them. My best friend is has Type 1 diabetes and uses an insulin pump. Her blood sugar levels get dangerously high if she is given prednisone. She can take Toradol, an NSAID, which is a blessing for her.

One of the biggest "issues" with prednisone is the weight gain factor. Prednisone actually causes weight to be redistributed to the face, abdomen and back, and it makes a person hungry. Not just hungry in the sense that you would like something to eat. But, hungry in the sense that you must have that bag of chocolate peanut clusters sitting on your kitchen counter............the whole bag The impulse to eat sweets can be overwhelming.

I have gained 25 lbs on prednisone and I didn't need to gain any weight at all. It has gotten to the point that I have decided that I need to take action.

One of the things I notice about my eating habits is that the worse I feel, the less consideration I put into what I am eating. I'm in pain. I'm tired. I just pick up whatever is handy and eat it when I am hungry. This is a big part of the problem.

In an attempt to modify my eating behavior during stressful times, I have take a few simple steps to help me eat a lower calorie, more nutritious diet. I do love vegetables, so that is a plus. The drawback is that veggies need washed and cleaned before they are ready to eat.

I have started buying celery in bunches, cleaning it, cutting it up and storing it in the refrigerator so that it is easy to grab. If it is time for lunch, and not just a snack, I may spread some peanut butter on the celery stalks. This provides protein and keeps the hunger pains away for awhile.

If you have an allergy to peanuts, or just don't like peanut butter, you could spread the stalks with cheese, or just eat them plain. I find that I crave vegetables, especially during the winter, and celery hits the spot sometimes. An entire cup of chopped celery only has 16 calories and is a great source of fiber and some vitamins. What's not to like?

I also keep baby carrots in my refrigerator for snacking, along with apples. Both of these food choices give me a sense of fullness and are also packed full of vitamins.

There seems to be some debate among rheumatologists about long-term use of prednisone. There are risks that are tied to higher doses of prednisone used over a long period of time. Rheumy's seem to agree about these risks, but I have read that some rheumatologist are now using a low dose of prednisone long term as a DMARD for those patients who seem to require it to keep their RA under control.

My rheumatologist, for instance, wanted me off of prednisone as soon as possible. I have tried twice to go completely stop prednisone. The first time I ended up in my orthopedic doc's office with ankles that looked more like grapefruits than ankles. It was painful to walk. Solution: 10 mg of prednisone and a slow taper back to 5 mg where I remained.

When I saw my rheumatologist a week or so later, my ankles were still swollen, but much better. She then told me to taper to 5 mg and stay there. Since that time, she has kept me at 5 mg, unless I flare. During a flare I go to 15 mg and taper back down to 5 mg. For me, 5 mg of prednisone is being used as a DMARD.

Ankle Swelling

Naturally, I have some concern about long-term use of prednisone, and I still have hopes of being able to taper off of it completely one day. On the other hand, I don't want my inflammtion to get so high that I end up with vasculitis or some other cardiovascular issue. These are big concerns for those of us with RA.

Carol Eustice, a writer for "About.com" has an article entitled, "Low-Dose Steroids Reduce Joint Damage Associated With Rheumatoid Arthritis". Carol's article states, "Low-dose steroids (I.e.glucocorticoids such as prednisone) can inhibit joint damage when prescribed early in the course of rheumatoid arthritis."

RA is a complex disease, and RA patients all have different responses to medications. We also have other health conditions that may limit our use of some medications.

High doses of prednisone, over a long period of time, can lead to diabetes, high blood pressure, osteoporosis, and other serious health conditions. I have been lucky so far. My low dose of prednisone daily has not raised my blood sugar level, even though I am pre-diabetic.

My goal is to lose some of this prednisone weight. If I can do that, I will reduce the pressure on my joints, perhaps lower my blood pressure, and be generally more healthy.

What are your views and experiences on taking low dose prednisone? Do you have any tips for controlling weight gain while taking prednisone?