Prednisone vs Cortisol

[navejasjoe]

My wife was diagnosed with PMR 29 months ago. She started at 15mg pred and has been tapering very slowly, now down to 10.5mg. Though she doesn't feel as "great" as she did at 15mg, she is grateful to be able to still get around with minimal pains. She recently ran into a friend who has had lupus for many years but had not seen my wife since she got PMR. Her friend had been on Prednisone at the outset of lupus for a few months but was taken off of it because of all the ill effects we have all heard about with this steroid. She has been on cortisol for some time now as this steroid was deemed not as dangerous, and at least for lupus, it has helped her tremendously. Has anybody on this site been on cortisol at any time for PMR and did it help at all? From what I have read on this site and talking to other people, prednisone is the only med that does anything for PMR. My wife has not yet discussed cortisol with her rheumy, but before we do, we wanted to get the respected opinions of people on this site.

Thank you,

Joe

[Hidden]

Hi Joe

She may be slightly confused, maybe it was Hydrocortisone she was talking about?

“Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone. It is produced in humans by the zona fasciculata of the adrenal cortex within the adrenal gland. It is released in response to stress and low blood-glucose concentration.”

My understanding is Prednisolone has better anti inflammatory properties than Hydrocortisone & is also longer lasting, Hydrocortisone is usually taken three times per day. PMRPro will explain better than me.

Best Wishes

MrsN

[SheffieldJane in reply to Hidden]

Wow! Angela! 😊

[PMRpro Ambassador]

MrsN has the basics perfectly right - don't know why she thinks I could explain better!

Cortisol is the naturally produced version, hydrocortisone is the synthetic version used as a medication. Despite being a more similar structure that doesn't mean it doesn't have side effects. Someone on the forum was switched to hydrocortisone because of no adrenal function and producing very little cortisol - and had to request to be put back on pred because her side effects with HC were awful.

It is preferred on the grounds the short period of action means the body is more likely to recover adrenal function - but if it is being used for PMR or GCA then the doses need to much higher to get the same antiinflammatory effect and split into at least 2 and often 3 times daily doses to maintain the effect over 24 hours. On average the duration of action of pred is nearer 24 hours, meaning single daily dosing is ideal for most people and that improves compliance.

Any of the corticosteroids could potentially help with PMR but they have differing efficacies and durations of action. All of them potentially have side effects and risks. Pred just fits particularly well for most cases and is particulalry useful for chronic use.

[navejasjoe in reply to PMRpro]

Thank you PMRpro and MrsN. Perhaps our friend meant to say that hydrocortisone is what she was using as meds for lupus. She told my wife that she was taken off of pred because her adrenal function was affected and her weight gain was not as pronounced when she took the hydrocortisone. And they told her prednisone would be too dangerous for her to take it for a very long time. That is why she was trying to convince my wife to see if she could get her doctor to change her from pred to hydrocortisone.

Joe

[piglette in reply to navejasjoe]

I am not sure that makes sense, your wife would still be taking a corticosteroid, pred or hydrocortisone. The adrenal function would be affected by any steroid that taking over the cortisol from the normal body production. In fact based on what I have read on this forum more people are happy with pred than hydrocortisone for PMR anyway. Hydrocortisone may work better for other illnesses, I don’t know. There may be some reason that pred seems to be the steroid of choice for PMR.

[PMRpro Ambassador in reply to navejasjoe]

Then I imagine she has been switched for adrenal function alone now. But they aren't that different and some doctors happily use pred for poor adrenal function. She may have been lucky with the HC - but we all know here that it is possible to avoid weight gain even on pred. It is like all medications - some people have one set of side effects, others have others.

And obviously they are among the fear pred brigade. Nothing "dangerous" about long term low dose pred if that is what is required.