Need Advice

[danvb]

I am 52, diagnosed with RA about 1 yr ago , suffered for a year before that. very hard to walk at times, sometimes I couldn't hold a cup of coffee. Doctor gave me some high doses of Prednisone and within a day I felt awesome! I could walk without my feet killing me, I could use my hands without severe pain. That lasted about a month but it was a mostly pain free month. I could do things that I hadn't been able to for a long time. I am now on 5mg of Pred 2x a day along with 15 mg Meth a week. After 6 months Dr had me cut back Pred by 2.5 mg at night. I felt pain by morning that I hadn't for some time, I continued Pred at lower doses and higher meth but pain continued. I bumped my self back up on the Pred as I had difficulty functioning with the pain. How long is it safe to be on 10 mg of Pred a day ? I would like to stop the Meth as I haven't noticed a difference taking it along with Pred ,and lowering my Pred had a immediate painful results. Any personal insight would be helpful.

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Hi danvb

I am on mycophenolate and think rheumy intention to reduce pred and substitute mycophenolate so although I can't help you with mext and pred reduction, you have highlighted an issue that may help me make my decision about reducing pred. The 2.5mg reduction seems a bit high even on another drug that should 'help " pred work. Still think something like dsns method would at least ease you down rather than drop you down and into pain. I would find it hard to drop by more than 0.5mg. I am sure someone on same combi of drugs will be along to help. good luck

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and see post on Prednisone vs Methotrexate

from a while back..will try and get details of poster

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Englishrose417 posted about similar issues and lots of discussion.

[PMRpro Ambassador]

Do you just have RA? If so and you don't think the mtx is doing much - your doctor should be trying a different DMARD. If any DMARD hasn't achieved a lot in 6 months it is usually time to move on - although it is very possible that it is doing a lot more than you think. But you are also not on the highest dose - perhaps you just need a bit more. This may give you some info:

rheumatoidarthritis.net/tre...

It is a different thing from PMR as I'm sure you know, pred is the only option here and most people - and their doctors - would be very unhappy about being on 10mg indefinitely. If you could get down to and manage on 7.5mg you might find a doctor who would agree - that is the same amount of steroid your body makes naturally but even so many doctors just don't like it.

The fact you felt pain the next morning suggests to me it was a reaction to the relatively large and sudden reduction in that nighttime dose. It would have been better to reduce 1mg at a time - or even 0.5mg at a time and then you might have managed to reduce further without that reaction.

But I think you really need to talk to your doctor - and if he isn't helpful, perhaps look for another.