You've Got to Love/Hate Prednisone
I’m probably the least addictive person you’ll ever meet. I have gallon plastic bags filled with unused pain medications from my many surgeries. When I was younger (and not nearly as wise as I am today) I tried taking up smoking but could never quite remember to actually smoke the cigarettes.
My real drug of choice – and the one I avoid as much as possible – is prednisone.
Prednisone is a corticosteroid and can be applied as a cream, taken as a pill, or injected. It’s used to help reduce inflammation caused by a wide range of causes. It has a close cousin, methylprednisolone, that is also used in the United States but is more widely used in Europe. As one of the major markers of RA is inflammation, if you have RA, it’s highly likely that you have or will take one of these drugs. You may be prescribed a taper which is a course of prednisone (or methylprednisolone) starting with a high dose that tapers down to nothing over a few days; or you may be prescribed an ongoing dose of prednisone as part of your treatment plan.
My rheumatologist always starts the conversation with, “I know you hate prednisone …” But the fact is, I love, love, love prednisone. It makes me feel wonderful. Things quit hurting. I have energy to spare. It is, quite literally, me on steroids. I’ve always suspected that the big red “S” on Superman’s chest stood for “steroids” and that’s exactly how prednisone makes me feel - super.
The problem is, I also hate, hate, hate prednisone because it has a dark side. While prednisone is quite effective as what it does, it comes at a cost.
I was gloating about losing a few pounds but lamenting the fact that I was afraid they’d come back since I was going to be on a low dose of prednisone for about a week. My friend (mistakenly) commented that the pounds would drop off once I was off prednisone. Unfortunately she was wrong. One of the primary side effects of the drug is weight gain and prednisone pounds are just like any other pound you put on – easy to gain but very hard to lose.
The list of side effects go on. They range from the relatively benign sleeplessness to the more serious physical and even mental issues of high blood pressure, glaucoma, increased glucose levels, propensity for osteoporosis and psychiatric disturbances.1
All this being said, prednisone and methylprednisolone are generally effective at what they do. For those of us with RA, steroids can reduce swelling, stave off or stop a flare, reduce pain, and reduce fatigue. When you’re curled up in a painful little ball without the energy to get out of bed, prednisone can be a miracle drug.
It can also be used as a preventative, which is how I usually take it. With my rheumatologist’s permission I will take a low dose when I know I’ll be under more stress – such as when I’m traveling. I also recently took it to help avoid a flare when I had to delay my monthly biologic infusion.
Prednisone and methylprednisolone are like the other drugs that rheumatologists have in their arsenal. They have extensive benefits but they’re powerful drugs that can have powerful side effects. Similar to NSAIDs, DMARDs and biologics, they need to be used with discretion and with a full understanding of how the drug might affect you.
Whether you love, hate or (like me) love/hate steroids, to get the greatest benefits with the fewest side effects, you should always strive for the lowest dosage possible for the shortest amount of time and only as your doctor directs.
Quiz: Which is NOT a common risk factor for osteoporosis?