What is the typical dose of prednisone (corticosteroid) for treating arthritis?

Prednisone Dosing for Arthritis

For inflammatory arthritis, prednisone should be dosed at 10-20 mg daily for mild cases and 1 mg/kg/day for severe cases, with tapering over 4-8 weeks as symptoms improve. 1

Dosing Based on Severity

Mild Arthritis (Grade 1)

• Initial therapy with NSAIDs (naproxen 500 mg BID or meloxicam 7.5-15 mg daily) for 4-6 weeks 1
• If NSAIDs are ineffective, start prednisone 10-20 mg daily for 2-4 weeks 1
• Consider intra-articular corticosteroid injection only if ≤2 joints affected and low-dose prednisone (10 mg/day) with NSAIDs is not effective 1
• If no improvement in 2-4 weeks, escalate to moderate arthritis management 1

Moderate Arthritis (Grade 2)

• Prednisone 20 mg daily for 2-4 weeks 1
• If no response in 2-4 weeks, increase to 1 mg/kg/day or equivalent 1
• If symptoms improve, taper corticosteroid over 4-8 weeks or until grade 1 1
• Consider rheumatology referral to confirm inflammatory arthritis 1

Severe Arthritis (Grade 3)

• Prednisone 1 mg/kg/day for 2-4 weeks, or until symptoms improve to grade 1 1
• If symptoms improve, taper corticosteroid over 4-8 weeks until grade 1 1
• Consider additional immunosuppression (methotrexate, sulfasalazine, leflunomide) if symptoms don't improve 1

Administration Recommendations

• Take prednisone in the morning prior to 9 am to minimize adrenal suppression 2
• Consider taking with food or milk to reduce gastric irritation 2
• For long-term therapy, alternate day dosing may be beneficial to minimize side effects 2
• Low-dose prednisone (≤10 mg/day) is often sufficient for maintenance therapy 3, 4
• Some patients may benefit from divided doses (e.g., 5 mg BID) for better inflammation control 3

Tapering Recommendations

• Taper slowly using 1 mg decrements every couple of weeks to a month 3
• For short-term therapy (2-4 weeks), taper over 4-8 weeks as symptoms improve 1
• For longer therapy, taper over >2 months depending on response 1
• Avoid abrupt withdrawal of therapy 2

Evidence for Low-Dose Therapy

• Low-dose prednisone (≤10 mg/day) has been shown to be effective in controlling inflammation and slowing radiographic progression in rheumatoid arthritis 3, 4, 5
• Some studies suggest doses as low as 3-5 mg/day can be effective for long-term management 6, 5
• Modified-release prednisone taken at bedtime may provide better control of morning stiffness compared to morning dosing 5

Important Considerations and Precautions

• Supplement with calcium (800-1000 mg/day) and vitamin D (400-800 units/day) to prevent osteoporosis 3, 4
• Monitor bone density with DEXA scans for patients on long-term therapy 4
• Consider prophylactic antibiotics for pneumocystis pneumonia for patients receiving ≥20 mg methylprednisolone or equivalent for ≥4 weeks 1
• Use proton pump inhibitors for GI prophylaxis in patients with higher doses 1
• Screen for hepatitis B and C before initiating additional immunosuppressive drugs 1
• Evaluate for latent/active TB before anti-cytokine therapy 1

Combination Therapy

• In rheumatoid arthritis, combining low-dose prednisone (5-10 mg/day) with methotrexate may provide better disease control and slow radiographic progression 1
• Initial combination of methotrexate with prednisone (tapered to 5 mg/day by week 8) is a common approach 1
• For severe polyarthritis, consider combination therapy with full doses of two pharmacologic modalities 1