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Prednisone: The awesome terrible drug for arthritis

Rheumatologists are known for prescribing prednisone for everything. In fact, it's our claim to fame when it comes to the Nobel prize, as it was awarded in 1950 for its discovery. Back then, we thought prednisone would be the ultimate solution to all rheumatology problems. It sure seemed that way, as it quickly and effectively made inflammation go away. Over the coming years, we quickly realized there was a price to pay for using prednisone. The list of side effects is long and serious. It is not a medication we want for anyone for a long period of time, if we can avoid it.

What are the troubles with Prednisone? It can cause:

  • Weight Gain

  • Increased appetite leading to weight gain

  • Poor sleep

  • Irritability

  • Mood changes

  • Skin thinning

  • Increased risk for infections

  • High sugars leading to diabetes

  • Bone thinning leading to osteoporosis and bone fractures

  • Cataracts

  • Heart Disease

The above is not a complete list but it sounds pretty terrible. And yet, prednisone today remains one of the most commonly used medications by rheumatologists. That's because it works quickly, relieves pain, reduced inflammation and improves quality of life.

So what to do? Of course, the answer is never simple or straight forward. Always have a good conversation with your health care provider before starting prednisone, but here are some principles.

  • Less is better than more. If you need prednisone, take it for the shortest amount of time that makes sense, at the smallest doses that are effective. A lot of the side effects listed above are dose dependent.

  • Don't take this warning to say you should never go on Prednisone. Having inflammation, pain and poor quality of life is no good either and bad for your health. Using prednisone to provide short term relief with a plan in place for the long term can make sense.

  • To repeat, a long term plan that does not involve prednisone is usually possible. Speak to your healthcare provider to make sure you have a plan to limit your prednisone use; talk about other medication options which may work as well but are safer (you can fine examples on our website!).

  • In some cases, prednisone in high doses is needed (usually life threatening conditions, example: vasculitis) or for a longer period of time (example: polymyalgia rheumatica for about 1 year). These are appropriate, but still ensure the above principles are being followed too.

  • In some cases, local steroids can be used (example: steroid injections into joints). These are generally much safer and can be appropriate for treatment of inflammatory arthritis.

Prednisone is great, but must be used properly. It should rarely if ever be used as a long term treatment without considering alternatives first.

What are your thoughts on prednisone?

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