What are the benefits and risks associated with longterm prednisone use when treating rheumatoid arthritis or other rheumatic diseases? Does shortterm 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 longterm. 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.
Dr. Zashin is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. 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 or considering the biologic drugs.
