Prednisone for Arthritis: Is It Worth the Risk?
Over 1.3 million Americans are living with rheumatoid arthritis (RA), according to the Arthritis Foundation. This autoimmune disease primarily affects the joints and causes swelling, stiffness, pain, fatigue and other side effects. Many children also suffer from juvenile idiopathic arthritis (JIA), which has some of the same symptoms as rheumatoid arthritis.
Doctors often recommend prednisone to treat rheumatoid arthritis and JIA. It's a corticosteroid drug that's very effective at relieving the symptoms of these diseases. Many people who take prednisone report significant improvement in their arthritis. And there are several studies to back up their claims.
For instance, in a two-year study published in the Annals of Internal Medicine patients who took 10 mg of prednisone had fewer symptoms (joint stiffness, swelling, and tenderness) and better grip strength after six months than patients who took a placebo.
During the study the prednisone group used fewer additional therapies, such as nonsteroidal anti-inflammatory drugs (NSAIDs) than the placebo group. After one and two years of starting the treatment, the prednisone patients also had less joint damage on X-rays. However, five patients given prednisone and two patients given placebo developed fractures in the small bones of their backs.
This study and others show that many people with arthritis can tolerate low-dose prednisone (five to 10 mg daily) for several years. However, aside from possible fractures, the drug carries side effects that range from annoying to dangerous. The worse adverse reactions occur when larger doses are taken.
Side Effects of Prednisone
The Johns Hopkins Arthritis Center lists the following conditions as side effects or prednisone:
- Weight gain
- Fluid retention
- Round face
- Facial hair
- Irritability and jitteriness
- A tendency to bruise easily
- Worsening of high blood pressure, diabetes and elevated cholesterol
Should You Take Prednisone for Arthritis?
The first step is to consult with your doctor to assess all your treatment options, especially if you have other conditions such as hypertension or diabetes. However, a review of several prednisone studies reveals that doctors believe it can be very effective in treating arthritis, so don't be surprised if he prescribes it.
One study suggests that the problem lies in how doctors approach prednisone treatment. In "The Use of Low-dose Prednisone in the Management of Rheumatoid Arthritis" researchers reported that many clinicians give doses that are too high. They pointed out that the possible side effects of low-dose prednisone can be anticipated, avoided and managed through preventative methods and the appropriate care.
The study authors recommend starting prednisone treatment early in your disease, usually in combination with a disease-modifying anti-rheumatic drug. They also advise that patients take 800 to 1,000 mg of calcium supplements daily, as well as 400 to 800 units of vitamin D. Patients should also have their bone density tested and be treated with biophosphonates to reduce the risk of fractures.
If you start prednisone treatment for rheumatoid arthritis, pay attention to the side effects, especially the more serious ones. Report them to your doctor and find out if a lower dose would be better for you.
Journal: Annals of Internal Medicine, Volume 136 Issue 1, page 1-12
Study Date: 1 January 2002
Study Name: Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis: Clinical Efficacy, Disease-Modifying Properties, and Side Effects. A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
Author(s): AA van Everdingen, JWG Jacobs, DR Siewertsz van Reesema, and JWJ Bijlsma
Journal: Bulletin on the Rheumatic Diseases, Vol. 50 No. 12
Study Date: 2001
Study Name: The Use of Low-Dose Prednisone in the Management of Rheumatoid Arthritis.
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