Re: RESEARCH - Lack of benefit over 2 years of low dose prednisolone for RA

[Guest guest]

a-

You miss my point. I am aware of the side effects of prednisone. I am also aware

that had I not taken prednisone when it was first prescribed I would not have

been able to walk.My RA responded to nothing else at the time. I did not want to

take pred- but I wanted to walk. There have been many breakthroughs and changing

philosophies on treatment- since I had to make that choice. I am currently on a

combo of Remicade, MTX and yes, prednisone. There have been no drugs that have

been miracle drugs where I have been concerned- but I am mobile and the pain I

live with is tolerable. I have suffered from side effects also- that I would not

wish on anyone here.I would hate to think,however, someone here - whose disease

and symptoms of disease was similarly unresponsive- would forego a drug

treatment recommended by a doctor because someone here- could not recommend

it-or were frightened out of taking it. The decision whether or not to take

prednisone or any corticosteroid is serious decision -question the hell out of

a doctor who recommends it. IT IS A DECISION HOWEVER THAT SHOULD BE MADE BY AND

BETWEEN A DOCTOR AND A PATIENT- period. I have really attempted to be diplomatic

in my responses to the posts to date.We should be sharing research. We should be

sharing personal stories and decisions. I don't disagree with any of that. You

have,however, said we do not make recommendations here. Unfortunately while that

should be true- it isn't true. I would not have responded if I had not read in a

post " I could not in good conscience recommend the use of prednisone.... " The

person was not a doctor- nor am I aware- had the person taken prednisone. The

research shared was fine- the recommendation was not. We are not doctors and

should not be dispensing medical advice- no matter how well intentioned. Enough.

-

--------- Re: [ ] RESEARCH - Lack of benefit over 2 years of low

> > >dose prednisolone for RA

> > >

> > >

> > >>

> > >> I have been on prednisone for over 10 years- the dose has varied but

> > drug

> > >> has been part of my treatment repertoire. Would I rather not be on it-

> > >> sure. It has caused problems and it has alleviated problems. While it

> > does

> > >> not modify the disease long term- it does help with inflammation and

> > pain.

> > >> Sometimes it is the only thing that does. It often keeps people mobile

> > >> until the right drug combination works. It has its place in a treatment

> > >> program - and should be discontinued- if possible- when possible.

> > >>

> > >>

> > >> -------------- Original message ----------------------

> > >> From: " "

> > >>>

> > >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> > >>>

> > >>>

> > >>> Lack of radiological and clinical benefit over two years of low dose

> > >>> prednisolone for rheumatoid arthritis: results of a randomised

> > controlled

> > >>> trial.

> > >>>

> > >>>

> > >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

> > >>> EA,

> > >>> Hampson R, Poon FW.

> > >>>

> > >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

> > >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> > >>> .Capell@...

> > >>>

> > >>> BACKGROUND: Evidence for disease modifying activity of low dose

> > >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> > >>> Studies

> > >>> showing radiological benefit suggest that continued treatment is

> > required

> > >>> to

> > >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

> > >>> prednisolone in early rheumatoid arthritis on disease activity over two

> > >>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

> > >>> with

> > >>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

> > >>> disease

> > >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

> > >>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

> > >>> outcome measure was radiological damage, assessed by the modified Sharp

> > >>> method. Clinical benefit was a secondary outcome. A proactive approach

> > to

> > >>> identifying and treating corticosteroid adverse events was adopted.

> > >>> Patients

> > >>> who discontinued sulphasalazine were offered an alternative DMARD.

> > >>> RESULTS:

> > >>> 90 of 257 patients eligible for the study refused to participate (more

> > >>> women

> > >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> > >>> factor,

> > >>> median age 56 years, median disease duration 12 months, female to male

> > >>> ratio

> > >>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

> > >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

> > >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

> > >>> were

> > >>> no significant differences in radiological score or clinical and

> > >>> laboratory

> > >>> measures at 0 and 2 years.

> > >>>

> > >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> > clinical

> > >>> benefit on patients maintained on a DMARD over two years. Low dose

> > >>> corticosteroids have no role in the routine management of rheumatoid

> > >>> arthritis treated with conventional disease modifying drugs.

> > >>>

> > >>>

> > >>> PMID: 15194574

> > >>>

> > >>>

> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> > stra

> > >>> ct & list_uids=15194574 & itool=iconabstr

> > >>>

> > >>>

> > >>>

> > >>>

> > >>>

> > >>> I'll tell you where to go!

> > >>>

> > >>> Mayo Clinic in Rochester

> > >>> http://www.mayoclinic.org/rochester

> > >>>

> > >>> s Hopkins Medicine

> > >>> http://www.hopkinsmedicine.org

> > >>>

> > >

> > >

> > >

> > >

[Guest guest]

,

Steroids can cause a form of psychosis, so your abnormal rage may have been a

mild form of that. I agree with Sue - no doctor in his right mind would

prescribe prednisone for you and no insurance company should disadvantage you

for not taking something which is medically totally contraindicated.

n

France

Re: [ ] RESEARCH - Lack of benefit over 2 years of low dose

prednisolone for RA

This brings up a question for me. I really can't take Prednisone. I have

been on it in the past for only short periods, and invariably I get a very

strong rage reaction on it. This is odd, because I am not a rageful person. It

also has been very frightening. Additionally, I am not willing to take

Prednisone because I also have an autoimmune thyroid disorder, and I am not

willing to take any drug that has weight gain as a side effect. And, I have had

a friend, and also now my husband, who have been on Prednisone because of

transplants (kidney for friend, bone marrow for husband). So, I have seen the

effects it has on people over time. Literally, my life would have to depend on

taking it for me to agree to take it.

How difficult is it going to be to get good RA treatment without being willing

to take Prednisone? I have good insurance, not an HMO, so they are willing to

pay for some better medicine.

[Guest guest]

,

Steroids can cause a form of psychosis, so your abnormal rage may have been a

mild form of that. I agree with Sue - no doctor in his right mind would

prescribe prednisone for you and no insurance company should disadvantage you

for not taking something which is medically totally contraindicated.

n

France

Re: [ ] RESEARCH - Lack of benefit over 2 years of low dose

prednisolone for RA

This brings up a question for me. I really can't take Prednisone. I have

been on it in the past for only short periods, and invariably I get a very

strong rage reaction on it. This is odd, because I am not a rageful person. It

also has been very frightening. Additionally, I am not willing to take

Prednisone because I also have an autoimmune thyroid disorder, and I am not

willing to take any drug that has weight gain as a side effect. And, I have had

a friend, and also now my husband, who have been on Prednisone because of

transplants (kidney for friend, bone marrow for husband). So, I have seen the

effects it has on people over time. Literally, my life would have to depend on

taking it for me to agree to take it.

How difficult is it going to be to get good RA treatment without being willing

to take Prednisone? I have good insurance, not an HMO, so they are willing to

pay for some better medicine.

[Guest guest]

,

I've had RA for close to 30 years and have never taken steroids for

it. I was on a dose pack once in my life for poison ivy, but other

than that I've never been on them. My doctors have discussed them

with me and I've told them that the side effects can be to severe and

I didn't want to take them. No doctor ever tried to make me take

anything I didn't want to. Steroids don't have to be part of RA

treatment. In the past, it was prescribed more frequently. If you

tell your doctor that you have a rage reaction, I highly doubt he

would prescribe them.

a

On Sat, 5 Mar 2005 12:44:06 -0800 (PST), <melmac2525@...> wrote:

>

> This brings up a question for me. I really can't take Prednisone. I have

> been on it in the past for only short periods, and invariably I get a very

> strong rage reaction on it. This is odd, because I am not a rageful person.

> It also has been very frightening. Additionally, I am not willing to take

> Prednisone because I also have an autoimmune thyroid disorder, and I am not

> willing to take any drug that has weight gain as a side effect. And, I have

> had a friend, and also now my husband, who have been on Prednisone because

> of transplants (kidney for friend, bone marrow for husband). So, I have

> seen the effects it has on people over time. Literally, my life would have

> to depend on taking it for me to agree to take it.

>

> How difficult is it going to be to get good RA treatment without being

> willing to take Prednisone? I have good insurance, not an HMO, so they are

> willing to pay for some better medicine.

>

>

>

>

> ---------------------------------

> Celebrate 's 10th Birthday!

> Netrospective: 100 Moments of the Web

>

>

[Guest guest]

,

I've had RA for close to 30 years and have never taken steroids for

it. I was on a dose pack once in my life for poison ivy, but other

than that I've never been on them. My doctors have discussed them

with me and I've told them that the side effects can be to severe and

I didn't want to take them. No doctor ever tried to make me take

anything I didn't want to. Steroids don't have to be part of RA

treatment. In the past, it was prescribed more frequently. If you

tell your doctor that you have a rage reaction, I highly doubt he

would prescribe them.

a

On Sat, 5 Mar 2005 12:44:06 -0800 (PST), <melmac2525@...> wrote:

>

> This brings up a question for me. I really can't take Prednisone. I have

> been on it in the past for only short periods, and invariably I get a very

> strong rage reaction on it. This is odd, because I am not a rageful person.

> It also has been very frightening. Additionally, I am not willing to take

> Prednisone because I also have an autoimmune thyroid disorder, and I am not

> willing to take any drug that has weight gain as a side effect. And, I have

> had a friend, and also now my husband, who have been on Prednisone because

> of transplants (kidney for friend, bone marrow for husband). So, I have

> seen the effects it has on people over time. Literally, my life would have

> to depend on taking it for me to agree to take it.

>

> How difficult is it going to be to get good RA treatment without being

> willing to take Prednisone? I have good insurance, not an HMO, so they are

> willing to pay for some better medicine.

>

>

>

>

> ---------------------------------

> Celebrate 's 10th Birthday!

> Netrospective: 100 Moments of the Web

>

>

[Guest guest]

I haven't missed your point at all . I just don't happen to

agree with it. We can just agree to disagree. Just let me say that

if my disease was unresponsive to any meds and my disease was severe,

I too would take steroids. There is no need to defend your decision

to take prednisone. We have many members that must take it, and most

feel like you do, in that they suffer from side effects that they

wouldn't wish on anyone. We also have a few members that take low

dose prednisone and have few if any side effects.

But the post you are referring to that you where is offering her

opinion started with the post " Request for advise " where the member is

being told by her rheumatologist that he wants her to try Enbrel, but

is told by her family doctor to take prednisone.

If any member asks this group their opinion on the two meds, I believe

the overwhelming majority would recommend to try a DMARD that could

possibly induce remission rather than a drug know to have the

potential for serious side effects, but not alter the course of the

disease.

n my opinion, isn't doing anything but giving the advise she was

asked for. I would have advised the same thing. It is always

emphasized to make these decisions with your doctor.

Discussing drug alternatives and providing research that states the

benefits and side effects of them is a big part of this group. Since

RA treatment is individual, we all have to make decisions as to our

own treatment. It is my hope that members will read the research

provided here and make educated decisions with their doctors.

But anytime anyone ever asks my advise if they should try Enbrel or

take prednisone, my answer would always overwhelming be ENBREL!!!! I

am in no way making a decision for that person or telling them to

forgo a certain medication. I am simply giving the opinion that is

being asked for.

a

On Sun, 06 Mar 2005 03:29:40 +0000, k.j.choate@...

<k.j.choate@...> wrote:

> a-

>

> You miss my point. I am aware of the side effects of prednisone. I am also

> aware that had I not taken prednisone when it was first prescribed I would

> not have been able to walk.My RA responded to nothing else at the time. I

> did not want to take pred- but I wanted to walk. There have been many

> breakthroughs and changing philosophies on treatment- since I had to make

> that choice. I am currently on a combo of Remicade, MTX and yes, prednisone.

> There have been no drugs that have been miracle drugs where I have been

> concerned- but I am mobile and the pain I live with is tolerable. I have

> suffered from side effects also- that I would not wish on anyone here.I

> would hate to think,however, someone here - whose disease and symptoms of

> disease was similarly unresponsive- would forego a drug treatment

> recommended by a doctor because someone here- could not recommend it-or were

> frightened out of taking it. The decision whether or not to take prednisone

> or any corticosteroid is serious decision -question the hell out of a

> doctor who recommends it. IT IS A DECISION HOWEVER THAT SHOULD BE MADE BY

> AND BETWEEN A DOCTOR AND A PATIENT- period. I have really attempted to be

> diplomatic in my responses to the posts to date.We should be sharing

> research. We should be sharing personal stories and decisions. I don't

> disagree with any of that. You have,however, said we do not make

> recommendations here. Unfortunately while that should be true- it isn't

> true. I would not have responded if I had not read in a post " I could not in

> good conscience recommend the use of prednisone.... " The person was not a

> doctor- nor am I aware- had the person taken prednisone. The research shared

> was fine- the recommendation was not. We are not doctors and should not be

> dispensing medical advice- no matter how well intentioned. Enough.

>

> -

>

>

>

>

> --------- Re: [ ] RESEARCH - Lack of benefit over 2 years of

> low

> > > >dose prednisolone for RA

> > > >

> > > >

> > > >>

> > > >> I have been on prednisone for over 10 years- the dose has varied but

> > > drug

> > > >> has been part of my treatment repertoire. Would I rather not be on

> it-

> > > >> sure. It has caused problems and it has alleviated problems. While

> it

> > > does

> > > >> not modify the disease long term- it does help with inflammation and

> > > pain.

> > > >> Sometimes it is the only thing that does. It often keeps people

> mobile

> > > >> until the right drug combination works. It has its place in a

> treatment

> > > >> program - and should be discontinued- if possible- when possible.

> > > >>

> > > >>

> > > >> -------------- Original message ----------------------

> > > >> From: " "

> > > >>>

> > > >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> > > >>>

> > > >>>

> > > >>> Lack of radiological and clinical benefit over two years of low

> dose

> > > >>> prednisolone for rheumatoid arthritis: results of a randomised

> > > controlled

> > > >>> trial.

> > > >>>

> > > >>>

> > > >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J,

> Thomson

> > > >>> EA,

> > > >>> Hampson R, Poon FW.

> > > >>>

> > > >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North

> Glasgow

> > > >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> > > >>> .Capell@...

> > > >>>

> > > >>> BACKGROUND: Evidence for disease modifying activity of low dose

> > > >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> > > >>> Studies

> > > >>> showing radiological benefit suggest that continued treatment is

> > > required

> > > >>> to

> > > >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose

> oral

> > > >>> prednisolone in early rheumatoid arthritis on disease activity over

> two

> > > >>> years. DESIGN: Double blind placebo controlled trial. METHODS:

> Patients

> > > >>> with

> > > >>> rheumatoid arthritis, duration <3 years (n = 167), were started on

> a

> > > >>> disease

> > > >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated

> by

> > > >>> stratified randomisation to prednisolone 7 mg/day or placebo.

> Primary

> > > >>> outcome measure was radiological damage, assessed by the modified

> Sharp

> > > >>> method. Clinical benefit was a secondary outcome. A proactive

> approach

> > > to

> > > >>> identifying and treating corticosteroid adverse events was adopted.

> > > >>> Patients

> > > >>> who discontinued sulphasalazine were offered an alternative DMARD.

> > > >>> RESULTS:

> > > >>> 90 of 257 patients eligible for the study refused to participate

> (more

> > > >>> women

> > > >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> > > >>> factor,

> > > >>> median age 56 years, median disease duration 12 months, female to

> male

> > > >>> ratio

> > > >>> 1.8:1. Prednisolone was given to 84 patients; of these 73%

> continued

> > > >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients

> on

> > > >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years.

> There

> > > >>> were

> > > >>> no significant differences in radiological score or clinical and

> > > >>> laboratory

> > > >>> measures at 0 and 2 years.

> > > >>>

> > > >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> > > clinical

> > > >>> benefit on patients maintained on a DMARD over two years. Low dose

> > > >>> corticosteroids have no role in the routine management of

> rheumatoid

> > > >>> arthritis treated with conventional disease modifying drugs.

> > > >>>

> > > >>>

> > > >>> PMID: 15194574

> > > >>>

> > > >>>

> > >

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> > > stra

> > > >>> ct & list_uids=15194574 & itool=iconabstr

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> > > >>> I'll tell you where to go!

> > > >>>

> > > >>> Mayo Clinic in Rochester

> > > >>> http://www.mayoclinic.org/rochester

> > > >>>

> > > >>> s Hopkins Medicine

> > > >>> http://www.hopkinsmedicine.org

> > > >>>

> > > >

> > > >

> > > >

> > > >

[Guest guest]

I haven't missed your point at all . I just don't happen to

agree with it. We can just agree to disagree. Just let me say that

if my disease was unresponsive to any meds and my disease was severe,

I too would take steroids. There is no need to defend your decision

to take prednisone. We have many members that must take it, and most

feel like you do, in that they suffer from side effects that they

wouldn't wish on anyone. We also have a few members that take low

dose prednisone and have few if any side effects.

But the post you are referring to that you where is offering her

opinion started with the post " Request for advise " where the member is

being told by her rheumatologist that he wants her to try Enbrel, but

is told by her family doctor to take prednisone.

If any member asks this group their opinion on the two meds, I believe

the overwhelming majority would recommend to try a DMARD that could

possibly induce remission rather than a drug know to have the

potential for serious side effects, but not alter the course of the

disease.

n my opinion, isn't doing anything but giving the advise she was

asked for. I would have advised the same thing. It is always

emphasized to make these decisions with your doctor.

Discussing drug alternatives and providing research that states the

benefits and side effects of them is a big part of this group. Since

RA treatment is individual, we all have to make decisions as to our

own treatment. It is my hope that members will read the research

provided here and make educated decisions with their doctors.

But anytime anyone ever asks my advise if they should try Enbrel or

take prednisone, my answer would always overwhelming be ENBREL!!!! I

am in no way making a decision for that person or telling them to

forgo a certain medication. I am simply giving the opinion that is

being asked for.

a

On Sun, 06 Mar 2005 03:29:40 +0000, k.j.choate@...

<k.j.choate@...> wrote:

> a-

>

> You miss my point. I am aware of the side effects of prednisone. I am also

> aware that had I not taken prednisone when it was first prescribed I would

> not have been able to walk.My RA responded to nothing else at the time. I

> did not want to take pred- but I wanted to walk. There have been many

> breakthroughs and changing philosophies on treatment- since I had to make

> that choice. I am currently on a combo of Remicade, MTX and yes, prednisone.

> There have been no drugs that have been miracle drugs where I have been

> concerned- but I am mobile and the pain I live with is tolerable. I have

> suffered from side effects also- that I would not wish on anyone here.I

> would hate to think,however, someone here - whose disease and symptoms of

> disease was similarly unresponsive- would forego a drug treatment

> recommended by a doctor because someone here- could not recommend it-or were

> frightened out of taking it. The decision whether or not to take prednisone

> or any corticosteroid is serious decision -question the hell out of a

> doctor who recommends it. IT IS A DECISION HOWEVER THAT SHOULD BE MADE BY

> AND BETWEEN A DOCTOR AND A PATIENT- period. I have really attempted to be

> diplomatic in my responses to the posts to date.We should be sharing

> research. We should be sharing personal stories and decisions. I don't

> disagree with any of that. You have,however, said we do not make

> recommendations here. Unfortunately while that should be true- it isn't

> true. I would not have responded if I had not read in a post " I could not in

> good conscience recommend the use of prednisone.... " The person was not a

> doctor- nor am I aware- had the person taken prednisone. The research shared

> was fine- the recommendation was not. We are not doctors and should not be

> dispensing medical advice- no matter how well intentioned. Enough.

>

> -

>

>

>

>

> --------- Re: [ ] RESEARCH - Lack of benefit over 2 years of

> low

> > > >dose prednisolone for RA

> > > >

> > > >

> > > >>

> > > >> I have been on prednisone for over 10 years- the dose has varied but

> > > drug

> > > >> has been part of my treatment repertoire. Would I rather not be on

> it-

> > > >> sure. It has caused problems and it has alleviated problems. While

> it

> > > does

> > > >> not modify the disease long term- it does help with inflammation and

> > > pain.

> > > >> Sometimes it is the only thing that does. It often keeps people

> mobile

> > > >> until the right drug combination works. It has its place in a

> treatment

> > > >> program - and should be discontinued- if possible- when possible.

> > > >>

> > > >>

> > > >> -------------- Original message ----------------------

> > > >> From: " "

> > > >>>

> > > >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> > > >>>

> > > >>>

> > > >>> Lack of radiological and clinical benefit over two years of low

> dose

> > > >>> prednisolone for rheumatoid arthritis: results of a randomised

> > > controlled

> > > >>> trial.

> > > >>>

> > > >>>

> > > >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J,

> Thomson

> > > >>> EA,

> > > >>> Hampson R, Poon FW.

> > > >>>

> > > >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North

> Glasgow

> > > >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> > > >>> .Capell@...

> > > >>>

> > > >>> BACKGROUND: Evidence for disease modifying activity of low dose

> > > >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> > > >>> Studies

> > > >>> showing radiological benefit suggest that continued treatment is

> > > required

> > > >>> to

> > > >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose

> oral

> > > >>> prednisolone in early rheumatoid arthritis on disease activity over

> two

> > > >>> years. DESIGN: Double blind placebo controlled trial. METHODS:

> Patients

> > > >>> with

> > > >>> rheumatoid arthritis, duration <3 years (n = 167), were started on

> a

> > > >>> disease

> > > >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated

> by

> > > >>> stratified randomisation to prednisolone 7 mg/day or placebo.

> Primary

> > > >>> outcome measure was radiological damage, assessed by the modified

> Sharp

> > > >>> method. Clinical benefit was a secondary outcome. A proactive

> approach

> > > to

> > > >>> identifying and treating corticosteroid adverse events was adopted.

> > > >>> Patients

> > > >>> who discontinued sulphasalazine were offered an alternative DMARD.

> > > >>> RESULTS:

> > > >>> 90 of 257 patients eligible for the study refused to participate

> (more

> > > >>> women

> > > >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> > > >>> factor,

> > > >>> median age 56 years, median disease duration 12 months, female to

> male

> > > >>> ratio

> > > >>> 1.8:1. Prednisolone was given to 84 patients; of these 73%

> continued

> > > >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients

> on

> > > >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years.

> There

> > > >>> were

> > > >>> no significant differences in radiological score or clinical and

> > > >>> laboratory

> > > >>> measures at 0 and 2 years.

> > > >>>

> > > >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> > > clinical

> > > >>> benefit on patients maintained on a DMARD over two years. Low dose

> > > >>> corticosteroids have no role in the routine management of

> rheumatoid

> > > >>> arthritis treated with conventional disease modifying drugs.

> > > >>>

> > > >>>

> > > >>> PMID: 15194574

> > > >>>

> > > >>>

> > >

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> > > stra

> > > >>> ct & list_uids=15194574 & itool=iconabstr

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> > > >>> I'll tell you where to go!

> > > >>>

> > > >>> Mayo Clinic in Rochester

> > > >>> http://www.mayoclinic.org/rochester

> > > >>>

> > > >>> s Hopkins Medicine

> > > >>> http://www.hopkinsmedicine.org

> > > >>>

> > > >

> > > >

> > > >

> > > >

[Guest guest]

, but you miss my point. You started prednisone over 10 years ago when

there weren't as many choices to treat RA and pain and, since then, much new

research has become available to guide the decision. RA patients choosing

NOW do so within a different framework.

Obviously, I am not a physician. I am assuming that people here factor that

in when they read my opinion. Nothing I suggest is meant to replace the

advice of an excellent physician. One of the most important outcomes would

be that the reader be provoked by me or a group discussion to have an

important dialogue with his or her physician.

The post from Suzanne that started this latest discussion on prednisone:

*******************************

Subject: Re: [ ] Request for advice

I am a two-year reader and have learned lots from all the generous

participants involved with the support group, for that I thank you.

If this has been mentioned, please be patient with me:

My rheumatologist is considering adding Enbrel or another drug since

the MTX seems to be less effective. No real pain but too much swelling for

her

liking.

The Primary Doc would rather I go back on prednisone.

Where can I find info about the positives and negatives of prednisone

vs another medication?

Thanks so much and have a happy, comfortable day,

Suzanne from PA

*******************************

My response:

*******************************

From: " "

Date: Fri Mar 4, 2005 11:54 am

Subject: Re: [ ] Request for advice

Suzanne, if you are lucky enough to have already weaned yourself off

of prednisone, please do not go back on it. For long-term use in RA, the

benefits do not outweigh the risks. Your rheumatologist should be able

to explain why your primary is mistaken.

To your MTX, you can add Azulfidine (sulfasalazine) or Plaquenil

(hydroxychloroquine) or both, or add Enbrel, Remicade, or Humira.

I'll post an article on this topic.

*******************************

Of the four articles I posted for Suzanne and the group, you took issue with

the last, an abstract: " Lack of radiological and clinical benefit over two

years of low dose prednisolone for rheumatoid arthritis: results of a

randomised controlled trial " ; July 2004 - The ls of the Rheumatic

Diseases

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15194574 & itool=iconabstr

You posted in response:

*******************************

From: k.j.choate@...

Date: Fri Mar 4, 2005 4:12 pm

Subject: Re: [ ] RESEARCH - Lack of benefit over 2 years of

low dose prednisolone for RA

I have been on prednisone for over 10 years- the dose has varied but

drug has been part of my treatment repertoire. Would I rather not be on it-

sure. It has caused problems and it has alleviated problems. While it does

not modify the disease long term- it does help with inflammation and pain.

Sometimes it is the only thing that does. It often keeps people mobile until

the right drug combination works. It has its place in a treatment program -

and should be discontinued- if possible- when possible.

*******************************

Though you are not a physician either, you directly contradicted, on the

basis of your personal experience, the conclusion of a study conducted on

167 people, which was: " Low dose prednisolone conferred no radiological or

clinical benefit on patients maintained on a DMARD over two years. Low dose

corticosteroids have no role in the routine management of rheumatoid

arthritis treated with conventional disease modifying drugs. "

At least I am trying to err on the side of caution. As you, I don't want

anyone here to suffer. There are many, many ways to treat pain and

inflammation, not just prednisone. And many of the options are much safer.

Nobody should be frightened about what they read. People on prednisone need

not despair. People do need to know the approximate risks/benefits ratio for

any given therapy before they begin it though. They also must be aware of

the potential side effects. This is even more important should the

medication in question be difficult to discontinue, as prednisone is. Any

troubling information should be discussed with one's physician.

As a wondered, I also worry about people who begin prednisone without

being told that they may never be able to discontinue it. I am also

concerned that they are not warned specifically about the side effects. I am

alarmed that physicians who prescribe prednisone long term don't always do

the treatment and monitoring of prednisone's side effects that they should

be. For example, taking preventative measures against prednisone-induced

osteoporosis is not being done faithfully. Large percentages of physicians

aren't bothering to take blood pressure readings at appointments.

While you worry that I may scare people away from prednisone, I worry that

you may persuade someone for whom it is not appropriate who then might be

stuck on prednisone for the next 50 years when it might, in the long run, do

them much more harm than good. Prednisone can be forever.

You said yourself: " Would I rather not be on it - sure. "

One very common side effect of prednisone - weight gain - is blown off by

many physicians as " minor. " In addition to the well-documented physical

effects that weight gain causes, there are strong psychological effects,

too. It's often mentioned here by members as a source of great frustration

and a loss of self-esteem. Not minor.

Also, if a person gains 30, 40, perhaps 50 pounds on prednisone, will that

actually help to keep the average person more mobile?

And weight gain is just the tip of the prednisone side effect iceberg.

In Suzanne's case, she's already gone through an initial course of

prednisone and is not in a lot of pain, but her rheumatologist doesn't like

the swelling. Given the choice between stepping up to Enbrel or reverting

to prednisone, I don't think too many rheumatologists would choose

prednisone, but I did ask Suzanne to talk to her rheumatologist about her

primary's suggestion. Did I think her primary offered her bad advice? Yes!

What if it seems that a person in the group is getting bad advice from his

or her physician? Are we allowed to say so? Are we allowed to suggest they

get a second opinion? Or is any individual physician's advice always

superior to that of the research, rheumatology organizations, or the

collective wisdom of the group?

As a noted, we won't always agree. That's fine. I actually think it's

better if we don't, since some of the best learning occurs when many aspects

of issue are discussed and conflicting opinions emerge.

Nobody is suggesting abandonment of sound medical advice from competent

physicians.

I believe we have a very intelligent group. Members can read and sort

through the various opinions and information, do additional research on

their own, talk to their physicians, and make their own decisions.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> a-

>

> You miss my point. I am aware of the side effects of prednisone. I am also

> aware that had I not taken prednisone when it was first prescribed I would

> not have been able to walk.My RA responded to nothing else at the time. I

> did not want to take pred- but I wanted to walk. There have been many

> breakthroughs and changing philosophies on treatment- since I had to make

> that choice. I am currently on a combo of Remicade, MTX and yes,

> prednisone. There have been no drugs that have been miracle drugs where I

> have been concerned- but I am mobile and the pain I live with is

> tolerable. I have suffered from side effects also- that I would not wish

> on anyone here.I would hate to think,however, someone here - whose disease

> and symptoms of disease was similarly unresponsive- would forego a drug

> treatment recommended by a doctor because someone here- could not

> recommend it-or were frightened out of taking it. The decision whether or

> not to take prednisone or any corticosteroid is serious

> decision -question the hell out of a doctor who recommends it. IT IS A

> DECISION HOWEVER THAT SHOULD BE MADE BY AND BETWEEN A DOCTOR AND A

> PATIENT- period. I have really attempted to be diplomatic in my responses

> to the posts to date.We should be sharing research. We should be sharing

> personal stories and decisions. I don't disagree with any of that. You

> have,however, said we do not make recommendations here. Unfortunately

> while that should be true- it isn't true. I would not have responded if I

> had not read in a post " I could not in good conscience recommend the use

> of prednisone.... " The person was not a doctor- nor am I aware- had the

> person taken prednisone. The research shared was fine- the recommendation

> was not. We are not doctors and should not be dispensing medical advice-

> no matter how well intentioned. Enough.

>

> -

[Guest guest]

, but you miss my point. You started prednisone over 10 years ago when

there weren't as many choices to treat RA and pain and, since then, much new

research has become available to guide the decision. RA patients choosing

NOW do so within a different framework.

Obviously, I am not a physician. I am assuming that people here factor that

in when they read my opinion. Nothing I suggest is meant to replace the

advice of an excellent physician. One of the most important outcomes would

be that the reader be provoked by me or a group discussion to have an

important dialogue with his or her physician.

The post from Suzanne that started this latest discussion on prednisone:

*******************************

Subject: Re: [ ] Request for advice

I am a two-year reader and have learned lots from all the generous

participants involved with the support group, for that I thank you.

If this has been mentioned, please be patient with me:

My rheumatologist is considering adding Enbrel or another drug since

the MTX seems to be less effective. No real pain but too much swelling for

her

liking.

The Primary Doc would rather I go back on prednisone.

Where can I find info about the positives and negatives of prednisone

vs another medication?

Thanks so much and have a happy, comfortable day,

Suzanne from PA

*******************************

My response:

*******************************

From: " "

Date: Fri Mar 4, 2005 11:54 am

Subject: Re: [ ] Request for advice

Suzanne, if you are lucky enough to have already weaned yourself off

of prednisone, please do not go back on it. For long-term use in RA, the

benefits do not outweigh the risks. Your rheumatologist should be able

to explain why your primary is mistaken.

To your MTX, you can add Azulfidine (sulfasalazine) or Plaquenil

(hydroxychloroquine) or both, or add Enbrel, Remicade, or Humira.

I'll post an article on this topic.

*******************************

Of the four articles I posted for Suzanne and the group, you took issue with

the last, an abstract: " Lack of radiological and clinical benefit over two

years of low dose prednisolone for rheumatoid arthritis: results of a

randomised controlled trial " ; July 2004 - The ls of the Rheumatic

Diseases

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15194574 & itool=iconabstr

You posted in response:

*******************************

From: k.j.choate@...

Date: Fri Mar 4, 2005 4:12 pm

Subject: Re: [ ] RESEARCH - Lack of benefit over 2 years of

low dose prednisolone for RA

I have been on prednisone for over 10 years- the dose has varied but

drug has been part of my treatment repertoire. Would I rather not be on it-

sure. It has caused problems and it has alleviated problems. While it does

not modify the disease long term- it does help with inflammation and pain.

Sometimes it is the only thing that does. It often keeps people mobile until

the right drug combination works. It has its place in a treatment program -

and should be discontinued- if possible- when possible.

*******************************

Though you are not a physician either, you directly contradicted, on the

basis of your personal experience, the conclusion of a study conducted on

167 people, which was: " Low dose prednisolone conferred no radiological or

clinical benefit on patients maintained on a DMARD over two years. Low dose

corticosteroids have no role in the routine management of rheumatoid

arthritis treated with conventional disease modifying drugs. "

At least I am trying to err on the side of caution. As you, I don't want

anyone here to suffer. There are many, many ways to treat pain and

inflammation, not just prednisone. And many of the options are much safer.

Nobody should be frightened about what they read. People on prednisone need

not despair. People do need to know the approximate risks/benefits ratio for

any given therapy before they begin it though. They also must be aware of

the potential side effects. This is even more important should the

medication in question be difficult to discontinue, as prednisone is. Any

troubling information should be discussed with one's physician.

As a wondered, I also worry about people who begin prednisone without

being told that they may never be able to discontinue it. I am also

concerned that they are not warned specifically about the side effects. I am

alarmed that physicians who prescribe prednisone long term don't always do

the treatment and monitoring of prednisone's side effects that they should

be. For example, taking preventative measures against prednisone-induced

osteoporosis is not being done faithfully. Large percentages of physicians

aren't bothering to take blood pressure readings at appointments.

While you worry that I may scare people away from prednisone, I worry that

you may persuade someone for whom it is not appropriate who then might be

stuck on prednisone for the next 50 years when it might, in the long run, do

them much more harm than good. Prednisone can be forever.

You said yourself: " Would I rather not be on it - sure. "

One very common side effect of prednisone - weight gain - is blown off by

many physicians as " minor. " In addition to the well-documented physical

effects that weight gain causes, there are strong psychological effects,

too. It's often mentioned here by members as a source of great frustration

and a loss of self-esteem. Not minor.

Also, if a person gains 30, 40, perhaps 50 pounds on prednisone, will that

actually help to keep the average person more mobile?

And weight gain is just the tip of the prednisone side effect iceberg.

In Suzanne's case, she's already gone through an initial course of

prednisone and is not in a lot of pain, but her rheumatologist doesn't like

the swelling. Given the choice between stepping up to Enbrel or reverting

to prednisone, I don't think too many rheumatologists would choose

prednisone, but I did ask Suzanne to talk to her rheumatologist about her

primary's suggestion. Did I think her primary offered her bad advice? Yes!

What if it seems that a person in the group is getting bad advice from his

or her physician? Are we allowed to say so? Are we allowed to suggest they

get a second opinion? Or is any individual physician's advice always

superior to that of the research, rheumatology organizations, or the

collective wisdom of the group?

As a noted, we won't always agree. That's fine. I actually think it's

better if we don't, since some of the best learning occurs when many aspects

of issue are discussed and conflicting opinions emerge.

Nobody is suggesting abandonment of sound medical advice from competent

physicians.

I believe we have a very intelligent group. Members can read and sort

through the various opinions and information, do additional research on

their own, talk to their physicians, and make their own decisions.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> a-

>

> You miss my point. I am aware of the side effects of prednisone. I am also

> aware that had I not taken prednisone when it was first prescribed I would

> not have been able to walk.My RA responded to nothing else at the time. I

> did not want to take pred- but I wanted to walk. There have been many

> breakthroughs and changing philosophies on treatment- since I had to make

> that choice. I am currently on a combo of Remicade, MTX and yes,

> prednisone. There have been no drugs that have been miracle drugs where I

> have been concerned- but I am mobile and the pain I live with is

> tolerable. I have suffered from side effects also- that I would not wish

> on anyone here.I would hate to think,however, someone here - whose disease

> and symptoms of disease was similarly unresponsive- would forego a drug

> treatment recommended by a doctor because someone here- could not

> recommend it-or were frightened out of taking it. The decision whether or

> not to take prednisone or any corticosteroid is serious

> decision -question the hell out of a doctor who recommends it. IT IS A

> DECISION HOWEVER THAT SHOULD BE MADE BY AND BETWEEN A DOCTOR AND A

> PATIENT- period. I have really attempted to be diplomatic in my responses

> to the posts to date.We should be sharing research. We should be sharing

> personal stories and decisions. I don't disagree with any of that. You

> have,however, said we do not make recommendations here. Unfortunately

> while that should be true- it isn't true. I would not have responded if I

> had not read in a post " I could not in good conscience recommend the use

> of prednisone.... " The person was not a doctor- nor am I aware- had the

> person taken prednisone. The research shared was fine- the recommendation

> was not. We are not doctors and should not be dispensing medical advice-

> no matter how well intentioned. Enough.

>

> -

[Guest guest]

Marina,

I think you're referring to the induction therapy trials I mentioned. It's

not an issue yet, but insurers will go for it if it can be shown to be a

cost-effective approach.

As for prednisone and pneumonia and DVT, I don't know that a direct

association between DVT and prednisone has been shown, but an association

between atherosclerosis and prednisone has been shown and, recently,

atherosclerosis has been linked to DVT.

Also recently, a study found that RA patients on prednisone are 170% (not a

typo!) more likely than those on other treatments to get pneumonia.

I will post these separately.

I wish I the wand, too!

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Re: RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

>

> Unfortunately, some insurance companies don't see it that way,

> . I have seen many instances of this, working in the hospital.

> It is unfortunate that insurance companies get to decide how a

> person should be treated for their particular ailment rather than

> letting the doctor, who treats that person, actually SEES that

> person, and has the experience to make those decisions, treat the

> person. Prednison also has it's long term problems as well. It may

> be cheaper to treat the problem with it now, but later it will have

> its toll--osteoporosis, cataracts, ect. I also use prednison. I

> was on 100mg a day at one point. I decided that I needed to get off

> of them and use them only as needed. I did it, it wasn't easy with

> the flares that insued. Now, however, I ony use it when a flare

> won't go away on its own. It is a wonderful, yet frighting,

> medication. I feel sooo much better when I am taking it because it

> brings the pain down to a tolerable roar. But, I also am acutely

> aware of the potential problems to follow with its use.

>

> But, on the flip side, low dosing prednison may have a befnifit not

> mentioned. It could be said to prevent DVT's or pneumonia because

> when it is taken, appropriately, it allows the user freedom of

> movement with less pain. The first reaction to pain is to not

> move. The less you move, the more problems that are surely to

> arise. DVT's are one example. Pneumonia can also set it if the pain

> leaves you bedridden. Treatment and long term affects can be costly

> there as well!!

>

> Now, if I could only find that magic wand!! Alas, the insurance

> company would probably deny its use anyway. Saying first you have

> to have this procedure first, and that medication next, before it

> would even CONSIDER the cure!!! LOL.....Marina

[Guest guest]

Marina,

I think you're referring to the induction therapy trials I mentioned. It's

not an issue yet, but insurers will go for it if it can be shown to be a

cost-effective approach.

As for prednisone and pneumonia and DVT, I don't know that a direct

association between DVT and prednisone has been shown, but an association

between atherosclerosis and prednisone has been shown and, recently,

atherosclerosis has been linked to DVT.

Also recently, a study found that RA patients on prednisone are 170% (not a

typo!) more likely than those on other treatments to get pneumonia.

I will post these separately.

I wish I the wand, too!

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Re: RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

>

> Unfortunately, some insurance companies don't see it that way,

> . I have seen many instances of this, working in the hospital.

> It is unfortunate that insurance companies get to decide how a

> person should be treated for their particular ailment rather than

> letting the doctor, who treats that person, actually SEES that

> person, and has the experience to make those decisions, treat the

> person. Prednison also has it's long term problems as well. It may

> be cheaper to treat the problem with it now, but later it will have

> its toll--osteoporosis, cataracts, ect. I also use prednison. I

> was on 100mg a day at one point. I decided that I needed to get off

> of them and use them only as needed. I did it, it wasn't easy with

> the flares that insued. Now, however, I ony use it when a flare

> won't go away on its own. It is a wonderful, yet frighting,

> medication. I feel sooo much better when I am taking it because it

> brings the pain down to a tolerable roar. But, I also am acutely

> aware of the potential problems to follow with its use.

>

> But, on the flip side, low dosing prednison may have a befnifit not

> mentioned. It could be said to prevent DVT's or pneumonia because

> when it is taken, appropriately, it allows the user freedom of

> movement with less pain. The first reaction to pain is to not

> move. The less you move, the more problems that are surely to

> arise. DVT's are one example. Pneumonia can also set it if the pain

> leaves you bedridden. Treatment and long term affects can be costly

> there as well!!

>

> Now, if I could only find that magic wand!! Alas, the insurance

> company would probably deny its use anyway. Saying first you have

> to have this procedure first, and that medication next, before it

> would even CONSIDER the cure!!! LOL.....Marina

[Guest guest]

I'm still reading your posts and trying to learn more about Prednisone. In

January I was in the hospital for Pneumonia. I had only the symptom of high

temperature. No coughing or breathing problems or other symptoms. The

pneumonia was hidden behind my heart, so I was told. I've been taking

Prednisone since 1990, fluctuating between 10 and 15 mg per day.

I tried last month to lower my dose to 9 mg but was unsuccessful. I started

alternating 10 one day and 9 the next. I went with that for 3 weeks, then

tried 9 mg per day. I didn't last for a week! I hurt so bad that I took 15

mg one day to get some control back. I guess I'm one of those that just

can't quit.

I finally chose a Medicare prescription card, but still can't afford Enbrel,

so I'm going to try sulfasalazine. I hope the card covers it, otherwise I

can't afford it either. Maybe Plaquenil is another choice. There must be

something that'll work.

Dennis

Re: [ ] Re: RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> Marina,

>

> I think you're referring to the induction therapy trials I mentioned. It's

> not an issue yet, but insurers will go for it if it can be shown to be a

> cost-effective approach.

>

> As for prednisone and pneumonia and DVT, I don't know that a direct

> association between DVT and prednisone has been shown, but an association

> between atherosclerosis and prednisone has been shown and, recently,

> atherosclerosis has been linked to DVT.

>

> Also recently, a study found that RA patients on prednisone are 170% (not

> a

> typo!) more likely than those on other treatments to get pneumonia.

[Guest guest]

I'm still reading your posts and trying to learn more about Prednisone. In

January I was in the hospital for Pneumonia. I had only the symptom of high

temperature. No coughing or breathing problems or other symptoms. The

pneumonia was hidden behind my heart, so I was told. I've been taking

Prednisone since 1990, fluctuating between 10 and 15 mg per day.

I tried last month to lower my dose to 9 mg but was unsuccessful. I started

alternating 10 one day and 9 the next. I went with that for 3 weeks, then

tried 9 mg per day. I didn't last for a week! I hurt so bad that I took 15

mg one day to get some control back. I guess I'm one of those that just

can't quit.

I finally chose a Medicare prescription card, but still can't afford Enbrel,

so I'm going to try sulfasalazine. I hope the card covers it, otherwise I

can't afford it either. Maybe Plaquenil is another choice. There must be

something that'll work.

Dennis

Re: [ ] Re: RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> Marina,

>

> I think you're referring to the induction therapy trials I mentioned. It's

> not an issue yet, but insurers will go for it if it can be shown to be a

> cost-effective approach.

>

> As for prednisone and pneumonia and DVT, I don't know that a direct

> association between DVT and prednisone has been shown, but an association

> between atherosclerosis and prednisone has been shown and, recently,

> atherosclerosis has been linked to DVT.

>

> Also recently, a study found that RA patients on prednisone are 170% (not

> a

> typo!) more likely than those on other treatments to get pneumonia.

[Guest guest]

Dennis,

Weaning off prednisone can be difficult when you've been on it for so

many years. That is not to say it is impossible, but you should talk

to your doctor about it. You may have to decrease your dosage by 1/2

mg at a time and stay at that new dose for several weeks before

decreasing it another 1/2mg. It's not something you can rush or

adrenal sufficiency can occur.

Have you tried contacting Immunex to see if you qualify for assistance

with Enbrel?

a

On Sun, 6 Mar 2005 15:27:00 -0600, Dennis W <betnden@...> wrote:

> I'm still reading your posts and trying to learn more about Prednisone. In

> January I was in the hospital for Pneumonia. I had only the symptom of high

> temperature. No coughing or breathing problems or other symptoms. The

> pneumonia was hidden behind my heart, so I was told. I've been taking

> Prednisone since 1990, fluctuating between 10 and 15 mg per day.

>

> I tried last month to lower my dose to 9 mg but was unsuccessful. I started

> alternating 10 one day and 9 the next. I went with that for 3 weeks, then

> tried 9 mg per day. I didn't last for a week! I hurt so bad that I took 15

> mg one day to get some control back. I guess I'm one of those that just

> can't quit.

>

> I finally chose a Medicare prescription card, but still can't afford

> Enbrel,

> so I'm going to try sulfasalazine. I hope the card covers it, otherwise I

> can't afford it either. Maybe Plaquenil is another choice. There must be

> something that'll work.

>

> Dennis

[Guest guest]

Dennis,

Weaning off prednisone can be difficult when you've been on it for so

many years. That is not to say it is impossible, but you should talk

to your doctor about it. You may have to decrease your dosage by 1/2

mg at a time and stay at that new dose for several weeks before

decreasing it another 1/2mg. It's not something you can rush or

adrenal sufficiency can occur.

Have you tried contacting Immunex to see if you qualify for assistance

with Enbrel?

a

On Sun, 6 Mar 2005 15:27:00 -0600, Dennis W <betnden@...> wrote:

> I'm still reading your posts and trying to learn more about Prednisone. In

> January I was in the hospital for Pneumonia. I had only the symptom of high

> temperature. No coughing or breathing problems or other symptoms. The

> pneumonia was hidden behind my heart, so I was told. I've been taking

> Prednisone since 1990, fluctuating between 10 and 15 mg per day.

>

> I tried last month to lower my dose to 9 mg but was unsuccessful. I started

> alternating 10 one day and 9 the next. I went with that for 3 weeks, then

> tried 9 mg per day. I didn't last for a week! I hurt so bad that I took 15

> mg one day to get some control back. I guess I'm one of those that just

> can't quit.

>

> I finally chose a Medicare prescription card, but still can't afford

> Enbrel,

> so I'm going to try sulfasalazine. I hope the card covers it, otherwise I

> can't afford it either. Maybe Plaquenil is another choice. There must be

> something that'll work.

>

> Dennis

[Guest guest]

No- you did not get my point- because my point was not to defend prednisone. I

have e-mailed privately. I have asked her to pass the e-mail along to you.

In short- I mentioned not only in that e-mail - but in an early response to the

research that such negative information about a commonly used drug did increase

anxiety - mine if noone elses- and the only response I got was another ten or so

articles further outlining the dangers of a drug that some of us are dependent

on. I do not get angry easily. I am furious. NO- you did not get my point. I

come here for support - not increased anxiety - and certainly not insensitivity.

--------- Re: [ ] RESEARCH - Lack of benefit over 2 years of

> > low

> > > > >dose prednisolone for RA

> > > > >

> > > > >

> > > > >>

> > > > >> I have been on prednisone for over 10 years- the dose has varied but

> > > > drug

> > > > >> has been part of my treatment repertoire. Would I rather not be on

> > it-

> > > > >> sure. It has caused problems and it has alleviated problems. While

> > it

> > > > does

> > > > >> not modify the disease long term- it does help with inflammation and

> > > > pain.

> > > > >> Sometimes it is the only thing that does. It often keeps people

> > mobile

> > > > >> until the right drug combination works. It has its place in a

> > treatment

> > > > >> program - and should be discontinued- if possible- when possible.

> > > > >>

> > > > >>

> > > > >> -------------- Original message ----------------------

> > > > >> From: " "

> > > > >>>

> > > > >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> > > > >>>

> > > > >>>

> > > > >>> Lack of radiological and clinical benefit over two years of low

> > dose

> > > > >>> prednisolone for rheumatoid arthritis: results of a randomised

> > > > controlled

> > > > >>> trial.

> > > > >>>

> > > > >>>

> > > > >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J,

> > Thomson

> > > > >>> EA,

> > > > >>> Hampson R, Poon FW.

> > > > >>>

> > > > >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North

> > Glasgow

> > > > >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> > > > >>> .Capell@...

> > > > >>>

> > > > >>> BACKGROUND: Evidence for disease modifying activity of low dose

> > > > >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> > > > >>> Studies

> > > > >>> showing radiological benefit suggest that continued treatment is

> > > > required

> > > > >>> to

> > > > >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose

> > oral

> > > > >>> prednisolone in early rheumatoid arthritis on disease activity over

> > two

> > > > >>> years. DESIGN: Double blind placebo controlled trial. METHODS:

> > Patients

> > > > >>> with

> > > > >>> rheumatoid arthritis, duration <3 years (n = 167), were started on

> > a

> > > > >>> disease

> > > > >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated

> > by

> > > > >>> stratified randomisation to prednisolone 7 mg/day or placebo.

> > Primary

> > > > >>> outcome measure was radiological damage, assessed by the modified

> > Sharp

> > > > >>> method. Clinical benefit was a secondary outcome. A proactive

> > approach

> > > > to

> > > > >>> identifying and treating corticosteroid adverse events was adopted.

> > > > >>> Patients

> > > > >>> who discontinued sulphasalazine were offered an alternative DMARD.

> > > > >>> RESULTS:

> > > > >>> 90 of 257 patients eligible for the study refused to participate

> > (more

> > > > >>> women

> > > > >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> > > > >>> factor,

> > > > >>> median age 56 years, median disease duration 12 months, female to

> > male

> > > > >>> ratio

> > > > >>> 1.8:1. Prednisolone was given to 84 patients; of these 73%

> > continued

> > > > >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients

> > on

> > > > >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years.

> > There

> > > > >>> were

> > > > >>> no significant differences in radiological score or clinical and

> > > > >>> laboratory

> > > > >>> measures at 0 and 2 years.

> > > > >>>

> > > > >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> > > > clinical

> > > > >>> benefit on patients maintained on a DMARD over two years. Low dose

> > > > >>> corticosteroids have no role in the routine management of

> > rheumatoid

> > > > >>> arthritis treated with conventional disease modifying drugs.

> > > > >>>

> > > > >>>

> > > > >>> PMID: 15194574

> > > > >>>

> > > > >>>

> > > >

> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> > > > stra

> > > > >>> ct & list_uids=15194574 & itool=iconabstr

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>> I'll tell you where to go!

> > > > >>>

> > > > >>> Mayo Clinic in Rochester

> > > > >>> http://www.mayoclinic.org/rochester

> > > > >>>

> > > > >>> s Hopkins Medicine

> > > > >>> http://www.hopkinsmedicine.org

> > > > >>>

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

No- you did not get my point- because my point was not to defend prednisone. I

have e-mailed privately. I have asked her to pass the e-mail along to you.

In short- I mentioned not only in that e-mail - but in an early response to the

research that such negative information about a commonly used drug did increase

anxiety - mine if noone elses- and the only response I got was another ten or so

articles further outlining the dangers of a drug that some of us are dependent

on. I do not get angry easily. I am furious. NO- you did not get my point. I

come here for support - not increased anxiety - and certainly not insensitivity.

--------- Re: [ ] RESEARCH - Lack of benefit over 2 years of

> > low

> > > > >dose prednisolone for RA

> > > > >

> > > > >

> > > > >>

> > > > >> I have been on prednisone for over 10 years- the dose has varied but

> > > > drug

> > > > >> has been part of my treatment repertoire. Would I rather not be on

> > it-

> > > > >> sure. It has caused problems and it has alleviated problems. While

> > it

> > > > does

> > > > >> not modify the disease long term- it does help with inflammation and

> > > > pain.

> > > > >> Sometimes it is the only thing that does. It often keeps people

> > mobile

> > > > >> until the right drug combination works. It has its place in a

> > treatment

> > > > >> program - and should be discontinued- if possible- when possible.

> > > > >>

> > > > >>

> > > > >> -------------- Original message ----------------------

> > > > >> From: " "

> > > > >>>

> > > > >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> > > > >>>

> > > > >>>

> > > > >>> Lack of radiological and clinical benefit over two years of low

> > dose

> > > > >>> prednisolone for rheumatoid arthritis: results of a randomised

> > > > controlled

> > > > >>> trial.

> > > > >>>

> > > > >>>

> > > > >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J,

> > Thomson

> > > > >>> EA,

> > > > >>> Hampson R, Poon FW.

> > > > >>>

> > > > >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North

> > Glasgow

> > > > >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> > > > >>> .Capell@...

> > > > >>>

> > > > >>> BACKGROUND: Evidence for disease modifying activity of low dose

> > > > >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> > > > >>> Studies

> > > > >>> showing radiological benefit suggest that continued treatment is

> > > > required

> > > > >>> to

> > > > >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose

> > oral

> > > > >>> prednisolone in early rheumatoid arthritis on disease activity over

> > two

> > > > >>> years. DESIGN: Double blind placebo controlled trial. METHODS:

> > Patients

> > > > >>> with

> > > > >>> rheumatoid arthritis, duration <3 years (n = 167), were started on

> > a

> > > > >>> disease

> > > > >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated

> > by

> > > > >>> stratified randomisation to prednisolone 7 mg/day or placebo.

> > Primary

> > > > >>> outcome measure was radiological damage, assessed by the modified

> > Sharp

> > > > >>> method. Clinical benefit was a secondary outcome. A proactive

> > approach

> > > > to

> > > > >>> identifying and treating corticosteroid adverse events was adopted.

> > > > >>> Patients

> > > > >>> who discontinued sulphasalazine were offered an alternative DMARD.

> > > > >>> RESULTS:

> > > > >>> 90 of 257 patients eligible for the study refused to participate

> > (more

> > > > >>> women

> > > > >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> > > > >>> factor,

> > > > >>> median age 56 years, median disease duration 12 months, female to

> > male

> > > > >>> ratio

> > > > >>> 1.8:1. Prednisolone was given to 84 patients; of these 73%

> > continued

> > > > >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients

> > on

> > > > >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years.

> > There

> > > > >>> were

> > > > >>> no significant differences in radiological score or clinical and

> > > > >>> laboratory

> > > > >>> measures at 0 and 2 years.

> > > > >>>

> > > > >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> > > > clinical

> > > > >>> benefit on patients maintained on a DMARD over two years. Low dose

> > > > >>> corticosteroids have no role in the routine management of

> > rheumatoid

> > > > >>> arthritis treated with conventional disease modifying drugs.

> > > > >>>

> > > > >>>

> > > > >>> PMID: 15194574

> > > > >>>

> > > > >>>

> > > >

> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> > > > stra

> > > > >>> ct & list_uids=15194574 & itool=iconabstr

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>> I'll tell you where to go!

> > > > >>>

> > > > >>> Mayo Clinic in Rochester

> > > > >>> http://www.mayoclinic.org/rochester

> > > > >>>

> > > > >>> s Hopkins Medicine

> > > > >>> http://www.hopkinsmedicine.org

> > > > >>>

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

a, that's exactly what I did, 10 mg one day and 9 the next. That's the

same thing, isn't it? Normally if I miss one dose, it takes a few days to

recover from it.

Wyeth has no program. The only assistance I qualify for is the MRDD, and

isn't any help. It was probably designed by Pres. Bush. If I can't afford

$100 a month for the cheaper drugs, I certainly can't pay $210. As I see it,

my only real choice is to try for Azulfadine and maybe it'll help me get off

Prednisone. One thing I'm also looking at is that I'll be 61 nest month. The

average life for a (married) man is about 71, so what is Prednisone going

to do to me in that amount of time? I'll try to get off it, but it'll not be

the end of the world for me if I can't.

Dennis

Re: [ ] Re: RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> Dennis,

> Weaning off prednisone can be difficult when you've been on it for so

> many years. That is not to say it is impossible, but you should talk

> to your doctor about it. You may have to decrease your dosage by 1/2

> mg at a time and stay at that new dose for several weeks before

> decreasing it another 1/2mg. It's not something you can rush or

> adrenal sufficiency can occur.

> Have you tried contacting Immunex to see if you qualify for assistance

> with Enbrel?

> a

>

>

> On Sun, 6 Mar 2005 15:27:00 -0600, Dennis W <betnden@...>

> wrote:

>> I'm still reading your posts and trying to learn more about Prednisone.

>> In

>> January I was in the hospital for Pneumonia. I had only the symptom of

>> high

>> temperature. No coughing or breathing problems or other symptoms. The

>> pneumonia was hidden behind my heart, so I was told. I've been taking

>> Prednisone since 1990, fluctuating between 10 and 15 mg per day.

>>

>> I tried last month to lower my dose to 9 mg but was unsuccessful. I

>> started

>> alternating 10 one day and 9 the next. I went with that for 3 weeks,

>> then

>> tried 9 mg per day. I didn't last for a week! I hurt so bad that I took

>> 15

>> mg one day to get some control back. I guess I'm one of those that just

>> can't quit.

>>

>> I finally chose a Medicare prescription card, but still can't afford

>> Enbrel,

>> so I'm going to try sulfasalazine. I hope the card covers it, otherwise

>> I

>> can't afford it either. Maybe Plaquenil is another choice. There must be

>> something that'll work.

>>

>> Dennis

>

>

>

>

[Guest guest]

a, that's exactly what I did, 10 mg one day and 9 the next. That's the

same thing, isn't it? Normally if I miss one dose, it takes a few days to

recover from it.

Wyeth has no program. The only assistance I qualify for is the MRDD, and

isn't any help. It was probably designed by Pres. Bush. If I can't afford

$100 a month for the cheaper drugs, I certainly can't pay $210. As I see it,

my only real choice is to try for Azulfadine and maybe it'll help me get off

Prednisone. One thing I'm also looking at is that I'll be 61 nest month. The

average life for a (married) man is about 71, so what is Prednisone going

to do to me in that amount of time? I'll try to get off it, but it'll not be

the end of the world for me if I can't.

Dennis

Re: [ ] Re: RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> Dennis,

> Weaning off prednisone can be difficult when you've been on it for so

> many years. That is not to say it is impossible, but you should talk

> to your doctor about it. You may have to decrease your dosage by 1/2

> mg at a time and stay at that new dose for several weeks before

> decreasing it another 1/2mg. It's not something you can rush or

> adrenal sufficiency can occur.

> Have you tried contacting Immunex to see if you qualify for assistance

> with Enbrel?

> a

>

>

> On Sun, 6 Mar 2005 15:27:00 -0600, Dennis W <betnden@...>

> wrote:

>> I'm still reading your posts and trying to learn more about Prednisone.

>> In

>> January I was in the hospital for Pneumonia. I had only the symptom of

>> high

>> temperature. No coughing or breathing problems or other symptoms. The

>> pneumonia was hidden behind my heart, so I was told. I've been taking

>> Prednisone since 1990, fluctuating between 10 and 15 mg per day.

>>

>> I tried last month to lower my dose to 9 mg but was unsuccessful. I

>> started

>> alternating 10 one day and 9 the next. I went with that for 3 weeks,

>> then

>> tried 9 mg per day. I didn't last for a week! I hurt so bad that I took

>> 15

>> mg one day to get some control back. I guess I'm one of those that just

>> can't quit.

>>

>> I finally chose a Medicare prescription card, but still can't afford

>> Enbrel,

>> so I'm going to try sulfasalazine. I hope the card covers it, otherwise

>> I

>> can't afford it either. Maybe Plaquenil is another choice. There must be

>> something that'll work.

>>

>> Dennis

>

>

>

>