From the Guidelines
For rheumatoid arthritis flares, prednisone is typically prescribed at a dose of 10-20 mg daily for short-term use, as recommended by recent guidelines 1. The goal of treatment is to use the lowest effective dose for the shortest time possible to control the flare, then return to maintenance therapy. In more severe flares, higher doses of 20-40 mg daily might be used initially, but this should be done under close supervision due to the increased risk of side effects. Key considerations include:
- Taking the medication in the morning with food to reduce stomach irritation and minimize sleep disturbances
- Gradually tapering the dose to minimize side effects once the flare is controlled
- Continuing regular rheumatoid arthritis medications as prescribed
- Monitoring for potential side effects, including weight gain, mood changes, increased infection risk, bone loss, and elevated blood sugar
- Contacting the healthcare provider if symptoms do not improve after several days of treatment or if severe side effects occur. It's also important to note that the use of prednisone should be carefully considered in patients with a history of steroid-related side effects or those at high risk of such effects, as highlighted in studies on polymyalgia rheumatica management 2. However, for rheumatoid arthritis flares, the most recent and relevant guideline evidence supports the use of prednisone at the mentioned doses, prioritizing the control of symptoms while minimizing the risk of adverse effects 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 In this latter situation, it may be necessary to increase the dosage of PredniSONE for a period of time consistent with the patient's condition.
The dosage of prednisone for rheumatoid arthritis flare is not explicitly stated, but the label suggests that the dosage may vary from 5 mg to 60 mg per day and should be individualized based on the patient's response to treatment and the severity of the disease. The label also mentions that the dosage may need to be increased during periods of exacerbation. 3
From the Research
Prednisone Dosage for Rheumatoid Arthritis Flare
- The recommended dosage of prednisone for rheumatoid arthritis flare is typically low, not exceeding 10 mg/day, and often given in daily divided doses (5 mg BID) 4.
- A study found that short-term use of low-dose prednisone monotherapy (mean dose 8 mg/day) induced disease remission and improved clinical severity of RA in newly diagnosed patients 5.
- The treatment of inflammation in RA with prednisone should be initiated as early as possible, usually with another DMARD, and tapering should be done slowly using 1 mg decrements every couple of weeks to a month 4.
- Supplemental daily calcium and vitamin D should be initiated with prednisone treatment to prevent potential side effects 4.
Management of Rheumatoid Arthritis Flares
- Flares in rheumatoid arthritis are common, with 54-57% of patients reporting more than one flare, and 30% of patients in remission reporting flares 6.
- The duration of flares can last from less than 1 week to more than 2 weeks, and longer duration of flares is associated with changes in disease-modifying therapy 6.
- Oral prednisone can be used as bridge therapy in rheumatoid arthritis patients, but rebound deterioration after tapering the dose can occur 7.
Use of Corticosteroids in Rheumatoid Arthritis
- The use of corticosteroids, including prednisone, has persisted over the past 20 years, with approximately one-third of patients having at least one annual prescription for corticosteroids 8.
- Rheumatologists prescribe corticosteroids less frequently and in lower doses than other physician groups, and there has been a significant fall in annual prescribed dose of prednisone by rheumatologists over time 8.