From the Guidelines
Prednisone should be considered for rheumatoid arthritis flares, particularly for short-term use, as it provides rapid relief of symptoms. According to the 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1, short-term glucocorticoids, such as prednisone, can be used for RA disease flares, with the goal of using the lowest possible dose for the shortest possible duration to achieve the best benefit-risk ratio.
Key Considerations
- The dose of prednisone for RA flares is typically in the range of 5-20 mg daily for 1-2 weeks, with a gradual taper afterward to minimize withdrawal effects.
- Prednisone works by suppressing the immune system and blocking inflammatory pathways, providing quick relief of pain, swelling, and stiffness.
- Potential side effects of long-term prednisone use include weight gain, bone loss, increased infection risk, and blood sugar elevation, emphasizing the need for short-term use and careful dose management.
- Prednisone is often used as a bridge therapy while waiting for disease-modifying antirheumatic drugs (DMARDs) to take effect or when adjusting DMARD therapy, as noted in the guideline 1.
Clinical Application
- Patients should be closely monitored for side effects and should never stop prednisone abruptly, following their healthcare provider's tapering instructions carefully to avoid adrenal insufficiency.
- The treatment target should ideally be low disease activity or remission, with glucocorticoids used to support this goal when necessary, as outlined in the guideline 1.
From the FDA Drug Label
In the event of an acute flare-up of the disease process, it may be necessary to return to a full suppressive daily divided corticoid dose for control. Because of the advantages of alternate day therapy, it may be desirable to try patients on this form of therapy who have been on daily corticoids for long periods of time (e.g., patients with rheumatoid arthritis).
Yes, prednisone may be prescribed for a rheumatoid arthritis (RA) flare. The drug label indicates that in the event of an acute flare-up, it may be necessary to return to a full suppressive daily divided corticoid dose for control 2.
From the Research
Prescribing Prednisone for Rheumatoid Arthritis Flare
- Prednisone, a corticosteroid, is often prescribed for rheumatoid arthritis (RA) flares due to its effectiveness in suppressing inflammation associated with RA 3, 4.
- Low doses of prednisone (less than 10 mg/day) are considered safe and effective in managing RA, with potential side effects being minimal and manageable with preventative measures and appropriate management 3, 4.
- The use of low-dose prednisone has been shown to retard bony erosions of RA, making it a valuable treatment option 3, 4.
- Prednisone can be used in combination with other disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, to enhance treatment effectiveness 5, 6.
- Long-term use of low-dose prednisone (less than 5 mg/day) has been found to be acceptable and effective for many patients with RA, with minimal adverse effects 6.
- Studies have shown that prednisone can be prescribed at a low dose, often with daily divided doses, and tapered slowly to minimize side effects 3, 4.
- The addition of supplemental daily calcium and vitamin D can help prevent osteopenia, a potential side effect of long-term prednisone use 3, 4.