This May seem like a trivial concern to those of you who are on long-term oral steroids, but I am quite worried, having been prescribed prednisolone 20 MG for seven days in order to control long-standing inflammation in my left foot.I am very reluctant to take it as I have already had numerous steroid injections over the course of the last four years in various joints and for the whole body too. My rheumatologist was quite insistent that, if the pain does not improve within two weeks, I should take this course of steroids. I already have osteoporosis in my spine and I’m concerned that it will make it worse or cause any other unwanted side effects. I have no access to the rheumatologist In order to seek reassurance, so I thought I’d ask you on here. At the end of the day, she left it up to me to make the final decision and I just Don’t know what to do for the best. From your experience, will a week of 20 mg oral steroids cause any damage or is that too short a course for anything major to happen? I realize that leaving my foot as it is could also cause damage, but it’s been going on for at least 18 months now and she has never tried to do anything about it before! I’d really appreciate your comments, even if it’s to tell me to stop being silly and just to take the steroids!
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It’s entirely up to you of course but if it were me I’d be guided by my rheumatologist who no doubt has years of experience and knowledge. If she thinks you need a short course of steroids to bring down the inflammation immediately that would seem sensible. 20mgs isn’t a huge dose - people with asthma have larger doses over a seven day period - and it may be exactly what you need to bet the acute inflammation under control. The oral dose may make you feel hungry and a bit wired for a week but it’s not going to have any long-term effects on your osteoporosis - that sort of thing happens over years - and I’m sure your consultant has taken that into account. If it doesn’t work and they need todo something else so be it but you never know, it might just be what you’ve needed for months. Best of luck and hope you’re pain free very soon.
I would not have thought that 20mg just for a week would not cause damage and should probably bring you some relief. I assume you will taper down after that rather than just stop.
I’m between RA drugs and have been really struggling. My Rheumy has prescribed me 20 mg for two weeks then reduce by 5mg after each subsequent two week period. I’ve also had loads of steroids in the past and have osteoporosis but could not manage without the Prednisolone at the moment. I’ve also got a foot problem but that is now more from osteoarthritis so I put Voltarol on the hurty bits (ankle mainly) and that brings some relief too. Good luck!
Hi Lolabridge,I’m sorry to hear that you are in pain too. I’m also just swapping from humira (which didn’t help much) to infliximab infusions and leflunomide. I think I just feel rather overwhelmed!
I’m sure you are right about the steroids and I will pull myself together (!) and start taking them this morning. No, she hasn’t said to taper down, but perhaps that is more essential if you have to take them for longer? Thanks for your help and advice. I hope you find a new medication which helps you. X
You are correct that tapering down is usually for longer term use. 7 days is usually fine and 20 mg isn’t huge. I started on 40mg and cannot get lower, it manages my lung fibrosis x
I’ve been on high dose steroids many times over last 6 years, I hate them but they do the job. When I had chemo I had to take 70mg for a week then just come off them for two weeks then back on when chemo started, I was ravenous and had so much energy that week, second week I felt like I had withdrawal symptoms, then I had a normal week before it all started again. I’m sure you will be fine on 20mg, it’s just the thought of being on them, we all hate them. Take care and good luck xx
Hi Lizard28, thanks for your reply. I took the first dose this morning and am now feeling totally “wired”. How on earth do you manage to sleep with higher doses? I just can’t get off to sleep at all!
I feel for you rock and a hard place. As others have said I doubt that a week of 20mg would do you any harm. Not long ago I had to have a week of 40mg and I was fine. Better to be out of pain and reduce the inflammation whilst you wait for other meds to sort you out 🤞. I’m sure your rheumatologist knows what is best for you.
Leics, I’m sure you’re right and I took the first dose this morning. I think I am already feeling the benefit but I am also totally “wired” and just can’t sleep. How on earth do you manage with higher doses?
I am on 20mg for a month then 15mg for second month down to 5 in increments over a 4 month period! I did have a "roid" rage incident on week 2 where I wanted to kill everyone, but that settled quickly with no dead bodies in sight!!The upside is at the moment I have no pain at all and the inflammation has receded enough to enable me to do some gardening over last three days, it's wonderful.
I have other conditions which complicate any treatment for my RA but with additional meds all is under control for now.
I didn't take the first lot of steroids for same reason as you, but pain so bad I gave them a try and glad I did.
Good luck, give them a go and hope your body starts behaving for you.
Hi Ernie52,Similar to you I have other conditions for which I need other medications- I feel like a walking pharmacy sometimes! I had just hoped to avoid the steroids. However, I started to take them this morning and I think I can already feel some benefit - but I just can’t get to sleep? How do you manage?
It affected me for about 3 days but sleeping well again now, just getting up for pee more often, that has become semi asleep job now too. Try not to worry about the things that could go wrong as I did, especially after reading the don't sue me leaflets!, But think of the relief of pain and inflammation. Don't forget steroids only kick your own body into doing its job better. I am actually repairing a neighbours clock today that's how much better my hands and wrists are at the moment. Good luck
I take long term steroids over 20 years. My maintenance dose is 7.5mg. I have osteopenia but still double my steroid and half my mycophenolate (immune suppression) at the slightest sign of infection.Steroids are anti inflammatory and can help prevent permanent joint damage.
Short course will be fine and are routinely prescribed for all ages including infants.
I regularly go on 20-30mg for inflammation or infection and as soon as I am done on 7 days I drop to normal amount. Over a week ( please note the GP knows how I do it) for me it works quicker than anything as I don’t have injections
Thanks Deeb1764,I had already had 12 injections over the last few years with the last one in my wrist only two weeks ago, so I was really hoping to avoid more steroids for now, if possible. But, I started to take them this morning and they already seem to be helping- and preventing me from getting off to sleep…
As others have already covered, 20mg is a relatively small and short dose when given over the course of a week. Your rheumatologist will have access to all your medical record including other medications, conditions etc. and will use this information to guide their treatment recommendations.
It's also worth remembering, that while adopting a stiff upper lip/ grin and bear it approach can be beneficial at times, it can also cause harm in the long run by exacerbating pain through continued use and even, spread to other areas through the act of your body compensating to avoid hurting the afflicted areas (or worse areas). So by using the steroids your body is less likely to try to compensate and cause possible further issues later down the line.
Many people feel a strong benefit to the short course of prednisolone and should you decide to take it, I hope it will alleviate your discomfort.
Should you wish to discuss this further or require any additional support, please don't hesitate to reach out to our helpline on freephone 0800 298 7650 or email us at helpline@nras.org.uk
Hi Hannah,Thanks for that detailed reply. I have started the course and am starting to feel the benefit with less pain. After not sleeping at all the first night , I am now managing a few hours by taking the steroid by 6 in the morning and avoiding caffeinated drinks for the rest of the day. I am not a good sleeper at all these days, so it doesn’t take much to throw me out completely! I think, with just having begun leflunomide and infliximab infusions with all the side effects they seem to bring with them, the oral steroids just seemed a step too far…anyway, now that I’ve “bitten the bullet” and started them, I can see the benefits.
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