What is the recommended dosing of Prednisone (prednisone) for Rheumatoid Arthritis (RA)?

From the Guidelines

Prednisone should be used at a dose of 10 mg/day or equivalent in patients with moderate or high Rheumatoid Arthritis (RA) disease activity, with the goal of using the lowest possible dose for the shortest possible duration to provide the best benefit-risk ratio for the patient. When considering the treatment of RA, it is essential to weigh the benefits and risks of glucocorticoids like prednisone, as they can provide rapid symptom relief but also have potential side effects 1. The 2015 American College of Rheumatology guideline recommends considering the addition of low-dose glucocorticoids, such as 10 mg/day of prednisone, in patients with moderate or high RA disease activity when starting disease-modifying antirheumatic drugs (DMARDs) and in patients with DMARD failure or biologic failure 1. Some key points to consider when prescribing prednisone for RA include:

• Using the lowest possible dose and for the shortest possible duration to minimize side effects
• Considering short-term glucocorticoids (defined as < 3 months treatment) for RA disease flares
• Aiming for a treatment target of low disease activity or remission
• Monitoring patients regularly for side effects, including elevated blood sugar, increased blood pressure, weight gain, mood changes, and bone density loss
• Recommending calcium and vitamin D supplements during treatment to mitigate potential bone density loss. It is crucial to prioritize the patient's benefit-risk ratio and adjust the treatment plan accordingly, taking into account the potential benefits of rapid symptom relief with prednisone while also considering the potential risks of long-term glucocorticoid use 1.

From the FDA Drug Label

The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT

The recommended dosing of Prednisone for Rheumatoid Arthritis (RA) is not explicitly stated in the drug label. However, the label does provide a general dosage range of 5 mg to 60 mg per day, which may be adjusted based on the individual patient's response to treatment 2.

• The dosage should be individualized based on the disease entity and patient response.
• The initial dosage should be maintained or adjusted until a satisfactory response is noted.
• After a favorable response, the maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals.

From the Research

Recommended Dosing of Prednisone for Rheumatoid Arthritis (RA)

• The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) recommendations endorse the use of glucocorticoids, such as prednisone, for RA patients' flares and as a bridge to a disease-modifying antirheumatic drug (DMARD) 3.
• Low-dose prednisone, typically defined as less than 10 mg/day, is considered safe and effective in the management of RA 4, 5.
• Studies have shown that low-dose prednisone can induce disease remission and improve clinical severity of RA in newly diagnosed patients, with a mean prednisone dose of 8 mg/day and a mean treatment duration of 42.2 days 3.
• The use of low-dose prednisone, often in daily divided doses (5 mg BID), can control most of the inflammatory features of early polyarticular RA, and retard the bony damage of RA 4, 5.
• Modified-release prednisone, administered in the evening, has been shown to reduce disease signs and symptoms by ≥20% according to the American College of Rheumatology criteria, and improve morning stiffness in patients with RA 6.
• Long-term use of prednisone in doses of less than 5 mg/day has been reported to be effective and acceptable for many patients with RA, with similar improvements in clinical status over 12 months and maintained for >8 years 7.

Dosing Considerations

• The initial dose of prednisone may be higher in patients with more severe disease, reflecting confounding by indication 7.
• Treatment with prednisone should not exceed 10 mg/day, and often may need to be given in daily divided doses (5 mg BID) 4.
• Supplemental daily calcium and vitamin D should be initiated with treatment to prevent osteopenia 4, 5.
• Tapering of prednisone should be done slowly using 1 mg decrements every couple weeks to a month 4.