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What to do - keep with prednisone or got to Biologics


I have had RA for about 7 years.

I am on methotrexate and hydroxychloroquine.

I had my worst flare up about 3 months ago and was in so much pain. My doctor gave me prednisone (20 mgs dropping to 5 mgs after 4 weeks) and it made a significant difference. When they ran out my GP kindly gave me some more and now I have been on prednisone for about 2 months (now taking either 5mgs or 10 mgs a day depending on how I'm feeling). The difference has been miraculous - pain very limited now and swelling (around knuckles and ankles) virtually gone.

My doctor wants to put me on a Biologic - is there any reason I can't continue the prednisone as it has been so wonderful so far - I have not asked the question of my doctor yet. I read about Biologics and the possible side-effects and it does frighten me.

Has anybody any experience of being on prednisone for long periods and what do you think of Biologics?

What are the downsides about long term prednisone use? As I want to feel the way I do forever!!

Any advice would be welcome.

Many thanks

  1. Hello,
    I'm also om Plaquanil (for seven years), Methotrexate (since January 2022), Folic acid and Prednisone on and off for several years but now I take 5mg per day every day. I'm not worried about Methotrexate as much as I am being on Prednisone everyday. I'm worried about getting brittle bones. I'm a woman at the menopause stage, so brittle bones is a concern regardless of being on Prednisone. So Prednisone will make things worse but if I stop the Prednisone my RA pain returns immediately. This is a vicious cycle we're in. The choices between the media and the side effects are very unfair. We pay a high price just to feel normal. I'm not at the biological phase yet but should I get there I'd welcome it. We've got to do what's necessary to stay as healthy and pain free as possible. I wish you the best. Having RA is like being in a maze but with several exits. Not one exit is better than the other. It's getting through the maze is what counts.

    1. Thanks very much Bnb. Were you on higher prednisone at some point ? Similar menopause stage here. R

  2. The word media was supposed to be MEDICATION

    Please excuse my typo

    1. I have been on both - heavy prednisone use ruined my body unfortunately. It took almost 10 years to get it back to some sort of shape that I wasn't completely disgusted at plus it disintegrated my teeth. I'm still trying to get off the last few mg of pred that I take daily. Biologics on the other hand ended up being the thing that finally got my illness under control after 20 years, so I can't say bad things about them. Yes, there are tons and you have to trial and error and there can be side effects but in the long run, the prednisone ate my bones for lunch! Keep on keepin' on, DPM

      1. Thanks very much Daniel - didn't realise it could be quite that nasty - so sorry. I'm still in the early stages of it. What happened with your teeth? Would you mind me asking which Biologic you have and what makes the doctors decide which on is right to start you off with? Sounds like you may have tried a few. Have you had any side effects? R

        1. I was all the way up to like 60-80mg a day at one point but even 10mg can lead to some side effects, at least for me. My doc is trying to get me down below 4.

        2. Hi . I want to start by stressing that everyone is different and, thus, the reactions to prednisone may be as well. My wife, Kelly Mack (a contributor here), like , was diagnosed with juvenile RA quite young. Kelly has been on 5mg of prednisone, with a prescription for 1mg tabs to add on bad days, for many years with no major known adverse effects. I think Kelly and Daniel may have actually discussed this fact that his doctors used prednisone at significantly higher levels than what Kelly ever had as they were growing up (note: we all know each other). That said, the difference in the side effects they have seen from long-term use still illustrates the differences in reactions. The research on low-dose prednisone also bounces around from finding few effects to potentially many. I wish I had a better answer for you other than trial and error and to monitor closely for adverse events (I know Daniel can back me up on this one). Wishing you the best and know that there are people here who understand. Richard ( Team)

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