Q: In the last 10 years I have had three episodes of arthritis that would not respond to any anti-inflammatory drugs but responded to Prednisone at a five milligram dose. The symptoms disappeared after two months. The last episode still persisted after two months and the doctor would not prescribe Prednisone because of its long-term side effects. I feel there is no “long range” at my age of 77 years. My general health is pretty good. What do you think?
A: This reminds me of a story about my 92-year-old uncle in England. When the BSE scare hit about 10 years ago, people were told that they could get Creutzfeld-Jakob dementia if they ate beef, and it could appear after 10 years. Beef suddenly became cheap, so my uncle said he was eating as much steak as possible so that it would make him live for another 10 years. He is still fine.
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The problem with Prednisone is that it has short-term as well as long-term side effects. You are at increased risk of gastrointestinal bleeding, osteoporosis and fractures. In addition, there is a nasty side effect that can cause a sudden deterioration of the hip joint called osteonecrosis. This might require a hip replacement.
You do not say which joints are involved, but because the condition responds to steroids, I assume it is some type of autoimmune disease such as rheumatoid arthritis, lupus or Reiter’s syndrome.
These all have a relapsing and remitting pattern and can clear up spontaneously without any medication.
If the arthritis persists, there are alternatives. A drug that is often used in cancer treatments called Methotrexate may be useful as it suppresses the immune system. You would be given a much lower dosage than a cancer sufferer. Antimalarial drugs have also been used.
Another possibility is a tetracycline type of antibiotic, for example, Minocin. This is given in a different way from treating an infection because you will need to take it about three times a week for several months. Again, it is working as an immunosuppressant rather than as an antibiotic.
There are several other newer drugs. Ask your family doctor to refer you to a rheumatologist or immunologist if he is unfamiliar with these methods of treatment.
If you still prefer to have the Prednisone, or if your condition does not respond to other medications, you might consider having the injectable type inserted directly into the affected joints. Before proceeding with steroids, you should have a bone density test performed.
If your bones are strong enough, it may be fine to have more Prednisone, but take it for as short a period of time as possible. You still need to discontinue the medication gradually because stopping it suddenly is not recommended.
Clare Rowson is a retired medical doctor living near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
