What are the benefits and risks associated with long-term prednisone use when treating rheumatoid arthritis or other rheumatic diseases? Does short-term use carry the same risks, or are risks tied to dose not the length of time a patient is on the drug?
Benefits of Prednisone Use
Prednisone is a type of corticosteroid that decreases inflammation relatively fast. As a result, it is a popular and useful treatment for inflammatory types of arthritis, such as rheumatoid arthritis. Recent evidence has shown that in addition to its ability to help people feel better by decreasing joint swelling, joint pain, and fatigue, it also has the capacity to slow joint damage.
In general, rheumatologists tend to use corticosteroids such as prednisone or prednisolone early in the disease to get quick control of the inflammation and until other disease modifying drugs can take effect.
Risks of Prednisone
While it is unclear if doses of prednisone of 3 mg or less have clinically significant toxicity, doses of even 5 mg per day carry the increased risk of:
- osteoporosis
- cataracts
- affecting lipids
Higher doses may have other potential toxicities including:
- decreased wound healing
- masking infection
- increasing the risk of infection
Certainly, there are patients with rheumatoid arthritis who remain on prednisone long term. In those cases, the doctor and patient must weigh the benefits of the drug, as well as its potential side effects, and consider the alternatives available when making the best treatment decision.
Answers provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book and also visit Dr. Zashin's website.
