Navigating corticosteroids: what to know about prednisone

by Linda Caddick, pharmacist Arthritis Assist

Prednisone is one of a group of medicines called corticosteroids, or steroids. These medicines are similar to hormones your body already makes naturally and can be very effective at reducing inflammation. In inflammatory arthritis conditions, such as rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and related conditions, prednisone may be used to help reduce swelling and ease pain and stiffness, especially during a flare or while waiting for other arthritis medicines to take effect.

Corticosteroids can work quickly, but they are not usually intended to be the only long-term plan for inflammatory arthritis. The dose and length of treatment depend on the condition being treated, how active the inflammation is, your other medicines, and your overall health. There is no single “right dose” that suits everyone, so it is important to follow the plan agreed with your doctor, nurse practitioner, or rheumatology team. 

Because side effects are more likely with higher doses and longer courses, corticosteroids are generally used at the lowest effective dose for the shortest possible time. If you are taking prednisone for more than a few days, or at a higher dose, your prescriber may recommend reducing the dose gradually rather than stopping suddenly. This is sometimes called tapering.

Tapering matters because your body may slow down its own steroid production while you are taking prednisone. Stopping too quickly can make you feel unwell. If you are concerned that prednisone is not working, do not stop taking it without medical advice. Instead, talk to your prescriber about the next steps. 

Many people take short courses of prednisone without any problems, but side effects can happen. Possible side effects include stomach upset, weight gain, raised blood pressure, changes in blood glucose, mood or sleep changes, increased infection risk, or thinning of the bones. Some risks depend on the dose, how long you take it, your age, other health conditions and other medicines.

Tell your healthcare team about all your medicines, including over-the-counter medicines, supplements and any recent steroid injections or inhaled or topical steroids. Also let them know if you have diabetes, high blood pressure, osteoporosis, glaucoma, stomach ulcers, a current or recent infection, or a history of significant mood changes. This helps them check for interactions and decide what monitoring is needed. 

• What dose should I take, and for how long?
• Do I need a tapering plan when it is time to reduce or stop prednisone?
• What side effects should I watch for, and when should I seek urgent help?
• Do I need monitoring for blood pressure, blood glucose, bone health, eye health or infection risk?
• Is it safe for me to have vaccinations while taking prednisone? This may depend on the dose, length of treatment and other medicines you are taking.
• If I am having surgery or develop an infection, should I keep taking prednisone or contact my doctor first?
• If I am taking prednisone long term, do I need to carry a steroid card or other written information about my steroid treatment? 

Prednisone can be an important medicine for managing inflammation, but it needs to be used carefully. Take it exactly as prescribed, keep regular check-ins with your healthcare team, and ask for advice before changing the dose. Most importantly: do not stop taking prednisone without medical advice, even if it does not seem to be helping.