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Can Prednisone Be Taken On A Lower Dosage To Treat Arthritis?

Posted on Tue, 3 Oct 2017

Question: following up on my question about the arthritis in my hands. I finished the prednisone and felt like a million dollars while on it. The swelling was down, the stiffness gone, it was amazing, however I am very averse to taking that drug. I know it is very damaging, however I understand it is necessary , a trade off, for a lot of people. My husband takes t often for his asthma, he has to breathe and he knows it's bad. my question before my follow up appointment is this; how small of a dose could I take to get that relief and quality of life back. and what would be the damage? It was amazing, but as soon as I stopped, it was all back. The dose was 15 mg for 5 days, then 10 for 5 days, then 5 for 5 days. Also, I was thrilled to hear that there is Joint replacement for small joints! Sign me up. I have too much life left and too much to do to be a hand cripple like I am quickly becoming. Any information would be greatly appreciated. Also , in my previous question , I noticed the word "bloodworm" instead of "bloodwork" sorry! Anxiously awaiting your replies.

Answered by Dr. Ivo Ditah (23 minutes later)

Brief Answer:
I will start with 5mg and titrate up!

Detailed Answer:
Hi and thanks so much for this query.

Because of the long term effects of using high doses of prednisolone, it is recommended to use the smallest dose needed for treatment. If your doctor chooses to continue with it, I will suggest he titrates from 5mg daily and only increases if this fails to address your symptoms. However, he could also use other medications such as non-steroidal anti-inflammatory drugs that do not have a similar side profile as prednisolone yet effective for long term use. Prednisolone remains the main drug when acute flare ups are observed.

I hope this helps and guides. I wish you well. Feel free to follow up with me for more information and clarifications if need be.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ivo Ditah (36 hours later)

So what would be the long term effects of only 5mg a day ? And also, do you think that amount would be enough to give any significant relief, on a daily basis? And again, what could possibly cause this to get this bad this quickly? And what non-steroidal anti inflammatory do you suggest? prescription, over the counter, what dose?

Answered by Dr. Ivo Ditah (24 hours later)

Brief Answer:
Very minimal!

Detailed Answer:
Hi,

The side effects profile of a smaller dose would be less likely to develop and might take a longer time. If they however develop, they would be practically the same. They often include fluid retention and weight gain, think of the skin, bone loss, poor sugar control, etc.

I will recommend Tylenol and Ibuprofen at regular doses for first line management. I will revert to steroids in the event of an acute flare.

I wish you well and open for further discussions as you please.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ivo Ditah (27 minutes later)

So what would the smallest dose be that would give me daily relief? forget flare ups. It is unbearable every day. I cannot even move my hands in the morning, and it is getting worse by the week, now they even get stiff and sore if I'm just not using them for about 30 minutes, like just sitting still or reading a book. Please ,I am not a baby, or a hypochondriac,'m tough but this has gotten me bad. I need to function. I am in constant varying degrees of pain all day. And I am already back to taking alive every day until my stomach acts up, I have to. what about joint replacements again/ Where should I go. I live about 100 miles from XXXXXXX Cornell in New York. I know they are one of the best. My son broke his neck in a snowboarding accident about 4 years ago and Dr. Angevine operated on him and it was nothing short of a miracle that he is not paralyzed. I would go there in a minute.

Answered by Dr. Ivo Ditah (2 minutes later)

Brief Answer:
Surgery is only as last resort!

Detailed Answer:
Hi,

How much works varies. The plan is to use the minimum dose that works. We start low and increase progressively until we get that magic dose that works best to address your symptoms. Surgery is not the way to go and most especially for smaller joints. I will not be leaning much towards that at this time.

In all, no one can say what magic minimum dose works for you. While it is pretty sure giving highest possible dose will work perfect, we must make a balance between the side effects and the benefits.

Are you currently of prednisone? If no, I will recommend you start with 5mg and increase to 10mg in a week if symptoms fail to improve significantly.

I wish you well and always available for further exchanges.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ivo Ditah (33 hours later)

Thank you for the reply. I don't understand why everyone and their mother is getting new knees, hips and shoulders in the past 10 years but why hasn't anyone replaced finger joints routinely? seems to be just as needed to me if not more. I remember how my mother suffered with arthritis in her hands but was otherwise perfectly healthy. It was inhibiting . anyway, that's not our topic here, everyone is getting new parts! Like an auto repair shop, but nothing for my tiny fingers that would help tremendously. Maybe soon. Is there a particular reason why they don't replace finger joints as much? I would like to know. And back to the prednisone, my dr put me on a 15 day round, 15 10 then 5mg, it was great but the pain was back almost immediately when I stopped, so I'mthinking 5mg would maybe be ok? Would that shorten my life?

Answered by Dr. Ivo Ditah (4 hours later)

Brief Answer:
Difficult to replace small joints!

Detailed Answer:
Hi,

It is so difficult to replace small joints and maintain their functions and dexterity. Of course they can be replaced but they would be less useful than if not replaced. Hopefully, research would be able to make this better in future.

I think 5mg of prednisone over a long time would be able to address your symptoms. I will not suggest that he stops it so soon.

Arthritis will not shorten your life. It might only limit the quality of life by causing pain and maybe limiting the use of your joints.

I hope this helps. I wish you well.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ivo Ditah (4 days later)

I didn't mean that the arthritis would shorten my life, I meant that being on prednisone everyday, even 5mg; would that shorten my life? if I felt the way I did when I was on it a few weeks ago, I wouldn't care if it shaved off a few years. The tradeoff would be worth it. Don't mean to get into hypotheticals, just thinking out loud.

Answered by Dr. Ivo Ditah (14 hours later)

Brief Answer:
Prednisone wouldn't shorten your life!

Detailed Answer:
Hi,

There is no evidence to suggest that prednisone reduces the number of live years. Be calm and get your symptoms controlled. Do not get anxious as you will never walk alone. We would be here, all the way on to support and provide the best available evidence based opportunities.

I wish you well. Always a pleasure hearing from you!

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar