Your Steroid Side-Effects Questions Answered
Taking medication is almost always part of the treatment game when you have a chronic inflammatory condition like rheumatoid arthritis, ankylosing spondylitis, or multiple sclerosis. And along with DMARDs and biologics that manage symptoms and prevent joint damage long-term, there's a very good chance you'll also be prescribed a steroid like prednisone along the way. But what exactly is this drug, and how does it affect the body? Keep reading to learn what you need to know about prednisone, including tips for how to lessen unwanted side effects.
When and Why Is Prednisone Used for RA?
Inflammatory autoimmune diseases need constant management. In an ideal scenario, prednisone is not a drug for long-term use—more like a couple of weeks, says Terri Tarrant, M.D., a rheumatologist at Duke Health in Durham, NC. While some medications target the root cause of inflammation, steroids can help relieve painful symptoms of, say, an RA flare, often while you’re waiting for longer-term drugs to start working. Doctors prescribe prednisone for RA because it provides fast pain relief, she says. “Prednisone can make someone feel better within hours to days and reduce the overall inflammation.”
How Does Prednisone Work?
Prednisone is an immunosuppressant, Dr. Tarrant says. Basically, it targets the body’s rogue immune cells and tells them to cool it. This is helpful because with an autoimmune disease, the immune system mistakenly attacks healthy tissue causing inflammation in the joints and body-wide. The catch with prednisone is that it suppresses the entire immune system—which means more unwanted risks and side effects, like increased risk of infection. That said, you can target specific joints by getting the drug injected into them, rather than taking it as a pill, which can reduce unwanted effects, says Dr. Tarrant.
What Are the Side Effects?
The downsides to taking prednisone range from mildly annoying to severe, based on your dosage and how long you take it. Possible side effects include the following: diarrhea and stomach pain, mood swings, insomnia, vision problems, hyperglycemia and diabetes, weakened bones, weight gain and facial swelling (“moon face”), and increased risk of infection. So how do you get the desired effect of this drug—reduced pain and swelling—and lower the risk of these unwanted side effects, or manage them should they strike? Read on for tips.
How Much Is Too Much?
Prednisone side effects largely depend on the dose you take, explains Kevin Deane, M.D., rheumatologist and researcher with the University of Colorado Health Rheumatology Clinic-Anschutz Medical Campus. Essentially, a low dose means fewer side effects, and a high dose (more than 20 mg per day) means more side effects. “It is helpful to have a mindset from the start that prednisone should only be used for low doses (under 10 mg per day if possible),” says Dr. Deane.
How Long Should I Take it?
Similarly, the longer you’re taking prednisone, the greater risk of side effects. In fact, some of the more serious side effects you hear about with prednisone—like thinning of bones (osteoporosis) and increased risk of infection—tend to be side effects from long-term use, says Dr. Deane (meaning more than a month or so). Again, he suggests going into treatment with a mindset that you'll use prednisone for a short time—ideally, two weeks or less.
Are Longer-Term Meds Better?
While starting longer-term drugs for RA management (typically disease-modifying anti-rheumatic drugs—DMARDs) can be daunting, it’s likely your best option to reduce irreversible joint damage and flare-ups—and it helps reduce your need for prednisone, which can have worse side effects over time than DMARDs. “It can be scary sometimes to think about taking some of these long-term DMARD medications for the rest of your life,” Dr. Tarrant says. “But if people get well-controlled on those medications and aren’t afraid to try them or start them, we don’t have to use steroids quite as much.”
What About GI Side Effects?
Tummy troubles like upset stomach, diarrhea, and a possible increased risk of stomach ulcers are some of the more immediate side effects of steroid use. To lower the chances of dealing with these, avoid taking your prednisone with nonsteroidal anti-inflammatory drugs like ibuprofen, says Dr. Deane. Your doc also may suggest you take an additional med to help protect your stomach, like a proton-pump inhibitor, he says.
Will Prednisone Affect My Sleep?
Insomnia can be a frustrating side effect of prednisone use since the drug can alter the natural balance of sleep-regulating chemicals in the body. If it gets really bad, you can talk with your doctor about adding a sleeping medication to your arsenal. That said, taking your prednisone dose in the morning can do the trick to help you avoid disrupted sleep, says Dr. Tarrant. “That’s when our normal steroid hormone naturally peaks,” she says. “If you take it at night, it’s going to disrupt the sleep-wake cycle.”
Can Exercise and Nutrition Help?
Weight gain usually crops up because the prednisone can cause you to retain fluids and increase your appetite. Healthy eating and exercise are key, says Dr. Tarrant. “It can be the anti-inflammatory diet, or it can just be a healthy, well-balanced diet,” she says. As for exercise, find aerobic activities you enjoy and can keep up with—even walking. “It doesn’t have to be intense at all. Having movement as part of your life does decrease inflammation overall and supports the tendons and muscles around your joints,” Dr. Tarrant says.
How Do I Protect My Bones on Prednisone?
If you’re taking long-term or high-dose prednisone, (again, this isn’t ideal and is becoming less common, Dr. Deane says), you’re at increased risk of osteoporosis. That’s because steroids can seriously interfere with bone formation. Your doctor should monitor you for this, says Dr. Tarrant. Calcium and vitamin D can help reduce your risk. Talk with your doc about how much to supplement with. They also may recommend you take a drug that specifically helps prevent bone loss called a bisphosphonate, he says. Diet and exercise also protect bone health.
How Do I Reduce My Risk of Infection From Prednisone Use?
Taking prednisone in high doses or for more than a month can put you at risk of an infection called pneumocystis pneumonia. “This can be prevented by using regular antibiotics such as sulfa antibiotics, or others if someone has a sulfa allergy,” Dr. Deane says. “Other infections such as regular pneumonia, urinary tract infections, and skin infections are also common, but healthcare providers don’t typically give antibiotics to prevent those.” For these, keep an eye out for the first sign of symptoms to get treatment as soon as possible.
Should I Ask to Tapering Off Prednisone?
Remember: The best practice for taking prednisone is low dose and short-term. While steroids are sometimes necessary to improve pain and inflammation levels, it’s important to talk with your doc regularly about things you can do to taper off steroids when you can, Dr. Deane says. There are likely longer-term medications you can try to get your chronic illness under control that offer fewer side effects and help reduce long-term damage, says Dr. Tarrant. Having a trusting relationship with your provider is key in finding the best treatment for you.
- Prednisone and Weight Gain: UCSF Health. (2020). “ILD Nutrition Manual: Prednisone and Weight Gain.” ucsfhealth.org/education/ild-nutrition-manual-prednisone-and-weight-gain
- Prednisone Side Effects: Creaky Joints. (2019). “6 Common Questions About Taking Prednisone for Rheumatoid Arthritis.” creakyjoints.org/treatment/prednisone-for-rheumatoid-arthritis/
- Review on Bone Health and Steroid Use: Current Opinion in Rheumatology. (2011). “Mechanisms of Glucocorticoid-Induced Osteoporosis.” pubmed.ncbi.nlm.nih.gov/21570035/
- Rheumatoid Arthritis Symptoms, Causes, and Treatments: The Mayo Clinic. (2020). “Rheumatoid arthritis.” mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648