INFO - Miscellaneous comments on prednisone by experts

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Ask the Doctor

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October 11, 2004

A. Paget, MD, FACP, FACR

Hospital for Special Surgery

Question:

Is it possible to combat RA disease with regular exercise and diet as

opposed to taking steroids to decrease joint inflammation?

Dr. Paget:

Regular exercise and diet are indeed very important parts of the treatment

of RA. Steroids such as prednisone can also be very helpful in controlling

inflammation but should never be used as the sole drug, and we try to use it

in short courses and not chronically. However, in this day and age, with our

amazing new medications for RA, exercise, diet and steroids alone are not

appropriate. Just imagine using leeches for the treatment of infections

after antibiotics were found to be effective. The same can be said to be

true today regarding RA. Since untreated RA (and the sole use of exercise,

diet and steroids would be considered untreated RA) will go on, inexorably,

to cause joint damage - and we can now avoid that with new medications - it

behooves you to strongly consider adding new, innovative medications to the

treatment plan that you mention.

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September 13, 2004

Gardner, MD

Question:

I have RA and prednisone helps me greatly, but it makes my face look swollen

and round and I also notice weight gain. Is there anything I can do about

that?

Dr. Gardner:

Prednisone is a wonderful horrible drug. It works quickly and works well for

RA, but the higher the dose and the longer the use the more chance of side

effects such as those you describe. Prednisone is often used as bridge

therapy, i.e., used initially to control inflammation until other

medications such as methotrexate that take several weeks to work to take

over control of the inflammation. It is important to know what else you are

on. And if you still need prednisone to be comfortable, you might need

additional therapy so that the prednisone can be reduced or hopefully

withdrawn.

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