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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Diagnosed with polychondritis. Prescribed prednisone for ear problems, arthritis pain. Reactive to high dose of prednisone. Small dose of prednisone or methotrexate?

Answered by
Dr. Luchuo Engelbert Bain

General & Family Physician

Practicing since :2009

Answered : 3092 Questions

Posted on Fri, 3 May 2013 in Arthritis
Question: I, supposidly, have polychondritis and was initially prescribed 40mg of prednisone to alilviate ear problems and
arthritic pain. Could not tolerate 40mg of prednisone, not even long term 20mg. Suggested I try methotrexate
along with 5mg of pred. Did not like sound of side effects of metho, so recently began with the 5mg of pred
on a continuous basis ( several weeks) and am tolerating it well and fairly free of poly symptoms. At this point
I would rather continue this reduced dose of prednisone , which seems to be working well, than begin the stronger
methotrexate medicine with its side effects. Do you concur? XXXXXX
Answered by Dr. Luchuo Engelbert Bain 4 hours later
Hi and thanks for the query,
Its true that most patients do respond differently to steroids, and present different side effects at different doses. I think the management of polychondritis prescribes higher doses of prednisolone from the start during the attack phase, and gradual tapering of the doses, with gradual tapering of the drug dose as symptoms subside. This should be why your Dr started with higher doses. Adding methotrexate was certainly because of the fact that you id not however support higher doses, and it was still important to attack the pathology, control inflammation best from the start before tapering.
Its great that you are responding clinically to low dose prednisolone. BUt the problem here is.
1st because the treatment might take a very long time, because the degree of inflammation will be controlled at a very small degree, and treatment become mainly symptomatic and might deserve to be taken for a very long time to achieve results. This shall paradoxically have the accumulated side effects of longterm exposure to steroids.
My suggestion is revisiting your physician for either prescription of long term acting steroids with milder side effects like Triamcinolones, good with low dose prednisolone and think with a keener look and might effort, you shall have spectacular positive outcomes in a very short while.
I pray you do not just stop Metho on your own, but discuss other treatment options first for alternatives wit your treating physician.
Thanks and best regards,
Luchuo, MD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Luchuo Engelbert Bain 19 hours later
You misunderstood. I did not start methotrexate med due to stated possible side
effects, but choose to use 5mg of predniisone to see how it worked out. Right
now it seems to be tolerated well and containing the arthritic pains. It seems to
be that continuous low dose prednisone is less threatening than long term methotrexate. Of course, if it does not address inflammation later, I would have to go on methothrexate. I cannot tolerate n-saids due to stomach problems.
Now, what do you think? I haven't suggested this switch to my rhuematologist as yet.
Answered by Dr. Luchuo Engelbert Bain 1 hour later
Hi and thanks for the update and clarification,
Its good you understand the prednisolone at 5mg would not really control the inflammation. I suggest you discuss with your rheumatologist. There are two options:
1. Raising the dosage of Prednisolone say to about 10mg a day and intensifying the surveillance of the markers of inflammation ,
2. And adding another anti rheumatic drug (Hydroxychloroquine, gold salts) to which you might be tolerant.
This deserves a consensus with you and your rheumatologist and shall certainly require strict observance of treatment.
Hope this helps and do not hesitate asking any further questions if need be.
Thanks and best regards,
Luchuo, MD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Luchuo Engelbert Bain 8 minutes later
Thanks for the follow -up. I might contact you later after contact with rheumatologist.
Answered by Dr. Luchuo Engelbert Bain 1 minute later
Hi and thanks for the response,
It would be my utmost pleasure to learn on the Rheumatologist' s decision.
Waiting as I wish you good health.
Best regards,
Luchuo, MD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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