From the Research
I recommend a 7-day prednisone taper starting at 30 mg for suspected inflammatory arthropathy, with a regimen of Day 1-2: 30 mg once daily, Day 3-4: 20 mg once daily, Day 5-6: 10 mg once daily, and Day 7: 5 mg once daily, as this approach minimizes the risk of adrenal suppression while providing anti-inflammatory benefits, as suggested by recent studies 1, 2.
Key Considerations
- The tapering approach should be gradual to minimize the risk of adrenal suppression, which can occur even with low-dose prednisolone treatment, as seen in studies 3, 2.
- Patients should be aware of potential side effects, including mood changes, increased appetite, fluid retention, and elevated blood glucose, and should contact their healthcare provider if symptoms worsen during the taper.
- The goal of therapy is to establish a hormone replacement regimen that closely mimics the physiological diurnal cortisol secretion pattern, tailored to the patient's daily needs, as highlighted in 4.
Important Points to Consider
- Adrenal insufficiency can occur in patients treated with prednisolone, even at low doses, and can cause symptoms that resemble disease flare, as seen in 2.
- The prevalence of adrenal insufficiency in patients with rheumatoid arthritis or polymyalgia rheumatica/giant cell arteritis can be high, ranging from 15% to 48%, as reported in 1, 3, 2.
- Strategies for adrenal function evaluation during ongoing low-dose glucocorticoid treatment need to be established, and patients should be educated on the risks of adrenal insufficiency and the importance of seeking medical attention if symptoms occur, as emphasized in 4.