Prednisone Use - Weighing the Benefits and Risks

Potent Corticosteroid Is Associated With Serious Side Effects

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What are the benefits and risks associated with longterm prednisone use when treating rheumatoid arthritis or other rheumatic diseases? Does short-term use carry the same risks? Are risks tied to dose rather than the length of time a person uses the drug? These are questions that must be asked because, while prednisone is an effective drug, it also is associated with side effects. Some of the side effects may be serious.

Benefits of Prednisone Use

Prednisone belongs to a class of drugs known as corticosteroids. Prednisone canĀ  decrease inflammation quickly. As a result, it is a popular and useful treatment for inflammatory types of arthritis, especially to bring a flare of symptoms quickly under control. In addition to its ability to help people feel better by decreasing joint swelling, joint pain, and fatigue, prednisone also may slow joint damage through its disease modifying properties in early rheumatoid arthritis.

Generally, in addition to managing flares, rheumatologists tend to prescribe oral corticosteroids, such as prednisone or prednisolone, early in the disease course to quickly control inflammation until other disease-modifying anti-rheumatic drugs (DMARDs) can take effect. DMARDs are slow-acting medications, so prednisone can be very helpful in the interim.

Risks of Prednisone Use

According to rheumatologist Scott J. Zashin, MD, "While it is unclear if doses of prednisone 3 mg or less are associated with clinically significant toxicity, doses of even 5 mg per day carry an increased risk of osteoporosis, cataracts, and affecting lipid levels.

Higher doses may have other potential toxicities including decreased wound healing, masking infection, and increasing the risk of infection." Other side effects associated with oral corticosteroids include:

  • Elevated eye pressure (i.e., glaucoma)
  • Fluid retention (i.e., edema in lower legs)
  • Hypertension
  • Psychological effects, including mood, memory, and behavioral changes
  • Weight gain (fatty deposits in the face, abdomen, back of neck)

Dr. Zashin continued, "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."

Longterm use of oral corticosteroids is associated with the following risks:

  • Cataracts in one or both eyes
  • High blood sugar,
  • Greater risk of infections
  • Osteoporosis and fractures
  • Suppression of adrenal gland hormone production
  • Thinning of skin, with increased bruising possible
  • Myopathy
  • Peptic ulcer disease

The issue with prednisone and other oral corticosteroids is that they affect the entire body, systemically, which make them more likely to be associated with significant side effects compared to corticosteroids that are administered topically or as a local injection.

It is important to be aware of potential side effects and try to minimize the impact.

Reducing Your Risk

While an awareness of the risks of prednisone use is the first step in managing potential side effects, there is more to be considered. You and your doctor may consider lowering your dose or using the drug for a shorter duration. Some people have an intermittent dosing schedule, where they take prednisone every other day. You should also pay attention to your diet and weight, more than usual, when taking prednisone. If you have been taking prednisone longterm, you should not discontinue the drug suddenly. Tapering the drug slowly will help you avoid or minimize side effects which can be caused by sudden discontinuation.

The Bottom Line

The risk of significant adverse events associated with prednisone or other oral corticosteroids is largely dose-dependent and time-dependent. Risks associated with low-dose prednisone use may actually be overestimated.

Sources:

Johannes W.G. Jacobs and Johannes W.J. Bijlsma. Chaper 60. Glucocorticoid Therapy. Kelley's Textbook of Rheumatology. Elsevier. Ninth edition.

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