Immunity Question

[montebello]

Hi all,

I'm a GCA patient since AUG 2022. Long story short, I've been more or less on high doses of PRED since then. Currently, I'm on 40 MG, and will be decreasing to 30 MG on THR and holding it there for 4 weeks before going down to 20.

My Rheumy has prescribed preventative antibiotics to protect me from pneumonia. I've mentioned this before to this group and received some excellent feedback. Apparently, such a recommendation is common here in the States, but not so common in Europe. My question, however, is not really about those antibiotics. It's about our immunities in general.

Not knowing the mechanism whereby prednisone affects our immunities, I'm wondering if there's a dosage below of which we are more-or-less back to normal. For example, if we have ZERO immunities at 60 MG PRED per day, do we have 50% of our natural immunities at 30 MG PRED per day, and 100% of our natural immunities at 0 MG PRED per day? I'm sure it's not that linear or logical but wondering if anyone can shed any light on this.

Thanks

[PMRpro Ambassador]

Not as simple as that - and not even starting with the concept of zero immunity at any given dose. Various immunosuppressants work in different ways, interfering with different mechanisms but pred has a fairly universal action - which is why it is so useful. However it still varies from person to person.

my.clevelandclinic.org/heal....

ncbi.nlm.nih.gov/pmc/articl...

[montebello in reply to PMRpro]

Thank you. The 2nd link would be especially helpful but I'm afraid it's beyond me. I guess I'm wondering how some rheumies can say that "you can stop taking antibiotics when you get down to 40 MG PRED," and some others say different things. Maybe it's just a matter of experience.

[PMRpro Ambassador in reply to montebello]

And many don't even start them for GCA ...

[SnazzyD]

one’s immune system isn’t a thing that is on or off and there are different parts to it, not all being affected equally. I have to say I had fewer infections on high doses than on low and was often the one without viral infections. That was on top of a condition that makes my neutrophils drop every three weeks. Covid affected my immune system way more than Pred ever did, but we are all different.

[montebello]

Thank you SnazzyD. Sure, I know our immune systems are a vastly complex thing to try to understand. Rules of thumb can be helpful though, and as I said to PMRPro, I'm wondering how some Rheumies and GPs can say that "you can stop taking preventative antiboitics at 40 MG PRED (for example). They have to be getting that sort of thing from somewhere.

[KASHMIRI1]

What a good question, l have often wondered that one myself and if taking Methotrexate as well makes you immune system even more compromised. Have you had a pneumonia vaccination?

[PMRpro Ambassador in reply to KASHMIRI1]

The vaccinations cover other causes of pneumonia, mainly viral I think. The antibiotic is for a bacterial pneumonia.

[KASHMIRI1 in reply to PMRpro]

Thank you for the information. Do you have any idea if methotrexate and pred make you more at risk from catching things than just pred alone?

[PMRpro Ambassador in reply to KASHMIRI1]

Probably. And if you do catch an infection when on methotrexate you should usually stop the MTX for a week or too to allow your immune system to fight off the infection. It isn't just the aspect of protecting you from catching things but also fighting the infection in the body.

[KASHMIRI1 in reply to PMRpro]

Thank you for your reply. That makes sense

[Sharitone in reply to KASHMIRI1]

When the govt put out the list of people who were extra immuno-compromised and would qualify for extra vaccines last year, those on MTX were included on the list, along with those on 20+mg pred, or biologics such as TCZ.

[KASHMIRI1 in reply to Sharitone]

Thank you

[montebello in reply to Sharitone]

Aha!!!!! That's what I was looking for. Much thanks

[Kneeknit]

I am not the person to answer your question. I was on prednisone but did not stayed too long on it. I wish you luck!

[Olympian]

Hi I am no expert but as I am now down to 4.5 mgs of Pred. I believe my immune system is working. To ensure all went smoothly as I tapered was to take it very slowly and overall it has worked for me. Wishing you good health as you move forward.

[Chipola]

Take whatever antibiotic you are offered. Here in the UK it's not usual and my husband was on prednisolone and methotrexate and not given one or any advice on distancing. He contracted pcp and it didn't end well . . .

[montebello in reply to Chipola]

Thanks for your advice, and so sorry about your husband.