From the Guidelines
For managing arthritic pain with prednisone burst therapy, the recommended initial dose is within the range of 12.5–25 mg prednisone equivalent daily, with a higher dose considered in patients with a high risk of relapse and low risk of adverse events. When considering burst therapy, it's essential to weigh the benefits of rapid symptom relief against the potential risks of corticosteroid use, as outlined in the 2015 recommendations for the management of polymyalgia rheumatica 1. Key principles in managing arthritic pain with prednisone include:
- Using the minimum effective individualised duration of GC therapy
- Individualising dose tapering schedules based on regular monitoring of patient disease activity, laboratory markers, and adverse events
- Tapering daily oral prednisone by 1 mg every 4 weeks once remission is achieved, as suggested in the management guidelines 1. It's crucial to note that the use of initial doses ≤7.5 mg/day is discouraged, and doses >30 mg/day are strongly recommended against, as per the guidelines 1. Patients should be aware of potential side effects, including mood changes, increased blood sugar, fluid retention, and insomnia, and those with diabetes should monitor their blood glucose more frequently during therapy. The goal of burst therapy is to provide rapid symptom relief for arthritic flares while minimizing the risk of serious adverse effects associated with long-term steroid use.
From the Research
Prednisone Dosing for Burst Therapy in Arthritic Pain
- The recommended dosing for prednisone burst therapy in managing arthritic pain is typically low-dose, with studies suggesting doses not exceeding 10 mg/day 2, 3.
- A study published in 2021 found that a short-term use of low-dose prednisone monotherapy (mean dose 8 mg/day) induced disease remission and improved clinical severity of rheumatoid arthritis in newly diagnosed patients 3.
- Another study from 2001 recommended that treatment of inflammation in rheumatoid arthritis should not exceed 10 mg/day and often may need to be given in daily divided doses (5 mg BID) 2.
- The duration of prednisone treatment can vary, with some studies using a 28-day taper regimen with 60 mg 4 and others using treatment durations of up to 6 months 3.
- It is essential to note that long-term use of low-dose prednisone can lead to adrenal insufficiency in some patients, highlighting the need for careful monitoring and management 5.
Considerations for Prednisone Treatment
- Supplemental daily calcium and vitamin D should be initiated with prednisone treatment to prevent potential side effects 2.
- Tapering of prednisone should be done slowly using 1 mg decrements every couple of weeks to a month 2.
- The effectiveness and safety of low-dose prednisone use in rheumatoid arthritis have been demonstrated in several studies, supporting its use as a valuable treatment option 2, 3, 6.