Prednisolone taper question?

Mat48

I have been on Prednisolone for just over a month now and am weaning off this week with the help of GPs. Last week I took 5mg for three days, then over the weekend down to 3mg for three days and today I moved down to 1mg - off completely on Wednesday.

What I wondered is that if the RA flare I was in before starting will likely just come back or might the Pred have knocked it on the head and things won't get back again for a few weeks? Drugs seem to linger on with me as a rule. I haven't ever taken it for this length of time before - previously two week bursts. I see my rheumy a week on Thursday and he was keen for me to have the steroid out of my system by then if possible.

The other thing is that it was a podiatrist who actually explained that I was flaring when I saw him a month ago - this based on his long experience with RA patients and family members and also because of the high inflammation levels in my feet. I hadn't realised I was flaring at all - just thought I was stressed and felt flu-like. So when I come off Pred completely is it likely that this is the state of flare I will go back to or might it come back much more assertively in different joints? I know you aren't medical people but some of you will have a lot more experience of coming of Prednisolone than I have at least and your advice would be most welcome.

PS and how might the Pred have affected my ESR when it's taken a week today?

dreamdaisy

The pred does two things, it thins the inflammation and cons us into thinking that we are feeling better and all is well. None of us can predict what will happen once you are off it, the RA will still be there, lurking and waiting, because that is what it does. You have a gorilla in your house and it's time to start living with it rather than denying its existence. Feeling stressed is an every-day thing for some but the 'flu like feeling is synonymous with a flare. I know when I am heading into a flare because the general aches escalate, I feel nauseously tired, and everything becomes a much harder effort. Today has begun like that.

You should be able to come of the pred this rapidly because you haven't been on it for that long. It maybe that you will intially feel worse but there again you may not. Who knows? I wish you well. DD

Mat48

Thanks DD. Please remember I was only diagnosed 2 years ago and the flu like stuff is relatively new to me. Previously RA being active meant excruciating pain in one or two joints or tendons - and naproxen used to sort this out within 24 hours. But having been off MTX injections for 3 and half months now and taking nothing at all apart from being randomly trialled on drugs for other secondary conditions such as restless legs and depression - I didn't see this last flare until I was right in the thick of it and needed an experiecd stranger to point it out :roll: I just didn't realise flares changed their guise and was waiting for the RA to flare up as it previously had. I know a bit more now about my RA - but not much! :?

Short bursts of Pred seem to be okay but only while I'm off immunosupressant drugs.
Mat x

dreamdaisy

I know you are only two years or so in to all this, I was trying to answer your questions but obviously failing, I apologise. Everyone's version of this malarkey is unique to them, I have to say that I am not aware of my flares changing in nature but then I don't have RA. DD

Mat48

Oops DD sorry if I sound stroppy - I am a bit just now but not with you - life is completely obstructive at my end re work and health presently so sorry if I repeat myself sometimes or come over as critical. I know how easy it is to forget people's stories here sometimes and was just reminding you and explaining to those who don't know me that I don't actually know my RA very well yet :?

I really wanted to know here is how soon the Prednisolone might wear off - based on the experiences of others who have taken it for about a month. I do realise that everyone is different in their responses to the drugs and I would be pragmatic about stories of coming off Pred for this reason. But its always useful to read of what people have been through with a drug we are taking too

Mat48

Ps interesting to learn that your PsA flares haven't changed that much. I suspect that when my rheumy diagnosed me and said that things might change and to report new symptoms he had a hunch that mine was the mixed connective tissue type of RA - where it might take a few years for one particular rheumatoid disease to manifest itself. I'm thinking of RA mixed with possible Sjogrens or Raynaud's or Sclorederma (sp). So this might explain why I've been so preoccupied with the symptoms and side effects over the time I've been coming in this forum perhaps?

Boomer13

Dear Mat;

I don't know if my experiences will help or not, because I have PsA not RA so it's a different process at work, though still inflammatory. I was on 15 mg prednisone for 2 years and I didn't really think it was doing anything at all. When I started to taper off it I immediately worsened, and developed new symptoms throughout the entire tapering process. Horrid. My illness was very active even though I was taking it and I wasn't in the care of a rheum at that time.

Now, I'm tapering off after being on it for 5 months and it's more complicated because I'm taking hydroxychloroquine, methotrexate and sulfasalazine. I've increased the mtx dose and started sulf. so I think with all of those interactions it's tough to say what is from prednisone just now. I'm in the final 2 weeks of the taper and have noticed only small increase in joint aching. I don't think I'm in a flare right now. Now I just wait to see what and when it will be triggered again.

I think if your disease is active you will have a return of inflammation quickly during the taper or once you come off it. I never have raised inflammatory markers in my blood so I can't use those before or after prednisone.

Hope that is helpful.
Anna

Mat48

Thanks Anna that is very helpful. I don't think PsA or RA are that different when it comes to steroids or meds generally but I may be wrong. The main difference is the time you took these for as your adrenal function takes longer to kick back into action the longer you've been taking Pred for.

I am stiffening and aching its true but I don't know how much of this is just that I know I am coming off Pred so it could just be psychosomatic? I really haven't learned how to recognise the signs of active disease as it seems to change it's face all the time for me.

And I'm becoming increasingly certain that whatever I have it's a mixed bag of autoimmunity - not straightforward RA. So I don't mind if my RA returns in time for my rheumy apt because I've had several consultations where I've had nothing to show for myself and been dispatched "see you again next year - keep taking the meth!" despite having mentioned neuro symptoms with no suggestions or further tests to get to the bottom of them. So I would like him to get the full picture and not one skewed by my having been on steroids. Mat x