Prednisolone - what side effects can be felt from the 'modest' daily dose of 7mg?

[heatherp]

I know this probably seems a really low dose to many who have had to put up with so much more, but my rheumy is thinking of introducing this on an ongoing basis so wondered what to expect?

[Gina_K]

Hi,

I believe that a dose of less than 7.5mg per day has been proved to have least side effects. Personally, I was on pred for two years and helped me greatly, really got me back on my feet. Built up to 10mgs & reduced to 7.5mg.

I was glad when I came off it too, but by that time a combination of Dmards were taking effect.

There is no getting away from the fact that a lot of people gain some weight, but with some effort this is shifted. Your life will be improved by this drug there is no doubt, but again you have to weigh up any perceived real or otherwise side effects. It only masks the condition, and acts as a bridge until correct dosages of Dmards or anti tnf bring the RA under control.

I hope this has helped in some way, and of course your primary source of discussion should be your doctors.

Regards, Gina.

[Mercedes]

I am only on 4mg a day and have been for years after weaning down from 10mg when I was first diagnosed in 1995. I have to take it in the morning or else I will have pred. induced insomnia. And I also still have the lovely MOON FACE. UGH. Figured at a low dose it would go, but apparently not. Other than that, I do fine.

[claireie]

I am on 15mg and have been for some time. I have had rituximab infusions but the last lot didnt work and I keep getting chest pains and its the only thing that works.

Due to have abatacept on Friday, so I hope that will work and can come down of the steroids. I dont have any side effects, but I think there will be long term. Been on them for 5 ish years, most of the time just 10mg. I cant function without it, and I'm just looking at day to day.

[claireie]

Forgot to say, I didnt put any weight on because I was active and totally inactive without them.

[Ailsa-NRAS Partner NRAS]

Hi Gina

I was on about 5 mg for 20 years and whilst it was probably the only thing that kept me going as I failed on all the standard DMARDs over time, I wish I had known the side effects it would have. I managed to get off them in 2004 thank goodness. I now have thin skin, bruise easily, there is the negative impact on bone so have osteopenia. Also the guidelines now state that you should not be on steroids long term but that they should be used to bridge the period when you are starting on DMARDS and before they take effect. At NRAS we are well aware that there are many people with long standing disease on on-going steroids who can't get off them but for newly diagnosed people, the way the disease is treated today is fortunately much better than when we were diagosed and we have the biologics so that if/when you fail on DMARDS there are other good options to treat the disease.

Hope this is helpful

BW

Ailsa

[Gina_K in reply to Ailsa-NRAS]

Hi Ailsa,

My mother-in-law has severe osteoporosis from long term steroid use, for a different condition. I was well aware of the side effects. As I said pred is a very effective drug as a bridging medication apparently.

There seems to be many people on them long term, which would seem to be of concern. When we are in pain, I suppose we would take anything. The sooner you can come off these little 'cure alls' the better, in my opinion.

It alway seems to me odd, that we are all so worried about side effects of Dmards & anti tnfs, but these seemingly harmless drugs do not scare people more. I suppose they are very cheap & so commonly prescribed.

Gina.

[heatherp]

Hi - thanks for the replies! Seems that as with most of these meds pred affects everyone differently! I'm actually on 2 DMARDS (leflunomide and hydroxy) that are working really well, but because lymphocytes are continually low and not improving (even after reducing lef to half dose) my rheumy has mentioned reducing it further to only 10mg every second day (was 20 pd originally), and then introducing low dose of pred. I also have an overlap with SLE which is what he believes is causing photosensitivity, so steroids would help that too.

Just a bit concerned as I've spent most of this year working on losing weight as my main joint problem was my ankle, and helped by the leflunomide I have lost over a stone, so not keen on putting it back on! My ankle has been so much better after losing weight, so not keen to put it back on! But as many of you say I need to weigh up the pros and cons...

[Gina_K]

I think weight gain is unavoidable with steroids. At least you have lost weight and will be starting from a good position, and as you may possibly be more active, maybe it will only be a few pounds gain,

Be sensible and do what doctor advises for your circumstances, you can always loose the weight when you are feeling better.

Good Luck. Gina.

[heatherp in reply to Gina_K]

Thanks again Gina - am seeing the rheumy tomorrow so will discuss with him. I've been doing a lot of reading on the subject and it seems that low doses can be very effective and have the least side effects, so let's hope! Just a bit nervous, but I guess we all are before we start a new drug (I remember before I started on MTX, which I was on for only 6 weeks as it caused severely low white blood counts, I was so nervous the day before because of everything everyone says about it, but to be quite honest hardly even noticed I was on anything - although obviously internally it was doing it's thing!)

It seems pred can give extra energy which I could really do with at the moment as I'm also studying for some exams and don't have much energy in the evenings after work for that these days! So I guess probably good to give them a go and see how things go...

xx

[abednegomonkey]

I have been on 20 mg for a while but now been reducing the dose down month by month. I managed to not put on any weight by following a slimming world diet. While others were losing weight, I was just happy staying the same... since reducing the dose I managed to lose one stone!! The thing to remember is that steroids make you FEEL hungry; so be careful what you snack on!! And eat wholesome meals regularly. It worked for me! I'd had previous experience of steroids a long time ago and put on half a stone in 4 weeks... so this time I was ready and aware.... so I hope my experience helps some people.

[arms4Luna]

On 20 mg of prednisone. Making me Cray, nasty, and gaining weight. Would like to split pill maybe using it three times a day. Any suggestions