The malign impact of Prednisolone

[south_nutter]

If weaned off the steroid A Will any bone/muscle damage be repairable B Likewise the adrenal gland C Also irregular heart beat D Is the sledgehammer of this treatment the only available resource for the inflammation involved.

[DorsetLady PMRGCAuk volunteer]

hi,

Sorry that you seem to be in a bad place with Pred, but there is no point in trying to wean off it until your PMR has gone into remission, and no-one can categorically tell you when that will be.

Answers - yes to all (but maybe with slight modifications, not quite as black & white as that)... but sledgehammer's do have their place in society...

and without this particular one I would be completely blind, so understandably I have great respect for it!

If you have a specific question then ask, and we will do our best to help.

[PMRpro Ambassador]

D) - Yes - and used properly it isn't really a sledgehammer. It has done me and many others very well. There is a biologic, tocilizumab, that would probably work but it is only approved for GCA so can only be used off-label for PMR though it is used in the USA and some eastern countries.

C) It depends - I have atrial fibrillation which caused my irregular heartbeat and it was nothing to do with pred. I had it long before pred, it was probably due to the autoimmune part of PMR damaging the electrical cells in the sinus node, they won't recover, so being off pred won't help me or anyone like me.

B) It depends - for the vast majority of long term pred patients adrenal funtion will return if they taper the dose below 8mg slowly enough. However, it seems to take rather longer than many doctors expect and doesn't really start to happen until under 5mg dose, in fact at 5mg the synacthen test may show no response, although in the same patient at 3mg things are happening. In a few cases it doesn't return.

A) If by bone damage you mean loss of bone density - possibly but it isn't inevitable even when on pred. My bone density is still near enough normal for my age, and better than many younger healthy patients, even after over 12 years on pred. There are more factors than just pred involved. I don't know whether muscle strength will get back to pre-pred levels, apart from anything else they are older, but Skinnyjonny managed to climb Annapurna IV after recovering from PMR and stopping pred.

Many factors are involved - duration and level of dose is obvious, but also what you have been able to do in the meantime. Some are able to continue or get back to previous activities sooner than others. One gentleman of over 80 was in a wheelchair at Easter, after a walking programme we suggested by Christmas he was back to skiing and teaching children's ski-school. In the summer he was riding his bike up and down mountains. That was in New Mexico - serious altitude!

[piglette]

I reckon I have had about fourteen steroid side effects. Slowly most have subsided as I reduce. I had real problem with my adrenal glands waking up, but taking it really slowly, they seem to have survived OK too. Like PMRPro my bone density is pretty good so far, although I had a Dexascan last week and have not had the result yet, but fingers crossed. In my opinion steroids are a wonder drug with some not so nice side effects.