Tapering from Prednisone after Relapse
Posted , 3 users are following.
Hi all,
I have Rheumatoid Arthritis and I've been taking Prednisone for a little over a year. I started at a dose of 60-70 mg a day and I finally tapered down to 15 mg a day. I had a horrible flare up and had to increase my dose back to 60 mg for about a week. I'm trying to taper back down but I'm having very painful muscle spasms in my neck and my back. My body hurts and I'm extremely fatigued. I also have an ulcer due to the long term use of the steroid and it's flaring up as well. How do I go about tapering back down to the 15 mg or close to? Any advice is welcome, please.
0 likes, 5 replies
EileenH morgan51636
Posted
It is possible the muscle spasms COULD be due to low magnesium levels, pred makes you lose magnesium through the kidneys, especially at a high dose. It won't hurt to try taking a magnesium supplement - don't take too much at a time, it can cause diarrhoea (that's what Epsom salts is). You can also try getting some Epsom salts and use them in the bath - magnesium can be absorbed through the skin too.
You should have been given a PPI when you were put on pred to reduce the possibility of gastric problems - if you were and even a high dose didn't prevent it perhaps your doctors need to have a rethink. Are you really only on prednisone for RA? That would be unusual I suspect - I don't have RA but I do read the RA forum. And if you have gastric problems then depot-Medrol injections might be better for you.
If you have only been on pred at 60mg for a week you can reduce back to 15mg quickly, certainly 10mg at a time, possibly every few days. Theoretically you could drop straight back to (say) 20mg after only a week but you might find it a bit uncomfortable getting used to the change of dose. Much longer than a week then you need to do it in a few steps.
Did your doctor not tell you what to do?
morgan51636 EileenH
Posted
I appreciate the reply, Eileen, thank you. I'm really hoping that since this was a sporadic increase in dose for only a week that I really can drop back down to 15-20 mg, no problem. I'd rather tolerate the issues that come with RA over the horrible muscle spasms in my neck and back. I almost can't function, they're so bad.
I do have another question about that, though. Is it the sudden drop in Prednisone that's causing the spasms due to withdrawal or is it the sudden increase to 60 mg for that week that's zapping my magnesium levels?
If it is withdrawal that's causing my pain, is there anything that I can do to relieve that while I taper back down?
EileenH morgan51636
Posted
Any amount of pred can lead to losing magnesium through the kidneys, I assume the more you take the bigger the risk. If the muscle spasms are so bad you really need to discuss it with your doctor because it may need something more targetted to get the spasm sorted out. It was the pain clinic here which had doctors who "got" it! But magnesium deficiency will persist until you supplement it. Other things can cause muscle spasm, calcium and potassium are also important, and that is why perhaps you should check with your GP or rheumy as they may want to check those.
cjb106 talks about the "10% rule" - that is something for tapering. There is no need to use it for dropping back to your "baseline" pred dose - the 10% rule is more important for long term doses and the adrenal gland problem only applies once you get down to the region of 10-15mg, until then the dose is more than the adrenals would produce naturally so you won't be at risk of being short of steroid which is essential for correct functioning of the body. If you used the 10% rule here you would remain at a very high dose of pred for a long time which is really neither pleasant nor good for you and should be avoided if possible.
"Steroid withdrawal rheumatism" is another problem - but again, after a short time on a dose dropping back to where you were shouldn't be too much of a problem although everyone would notice a change in dose that big. It will improve after a few days. Some rheumatologists would say to use painkillers for any pain - preferably not NSAIDs though (ibuprofen etc) though others say to use them. You should discuss that with YOUR rheumy.
But you haven't said if you are on anything else for the RA - it woud be very unusual for pred alone to be used except to damp down a flare until other medication kicks in.
cjb106 morgan51636
Posted
70 - 65 = 7%
65 - 60 = 8%
60 - 55 = 8%
55 - 50 = 9%
50 - 45 = 10%
45 - 40 = 12%
40 - 35 = 13%
35 - 30 = 14%
30 - 25 = 16%
25 - 20 = 20%
20 - 15 = 25%
15 - 10 = 33%
10 - 5 = 50%
5 - 0 = 100%
The bigger the percentage reduction, the more difficult it is for the body (the adrenal glands) to adapt quickly enough to the lower dose and this can trigger a relapse of symptoms. Aches, pains and extreme fatigue are all part of the withdrawal process made worse if coming down too fast.
So my advice is to come down by no more than 10% and be guided by how your body is responding. Using the figures above, when you get to 45mg, next go 41mg, 37mg, 34mg, 31mg, 28mg and so on (I’m always rounding down to nearest whole number.) You can get Prednisolone in 1mg tabs as well as 5mg. See how your body feels after each reduction and if you feel unwell with fatigue and pain, stabilise at that dose until you feel better.
As you know, rheumatoid arthritis is an autoimmune disease that causes inflammation in the joints. Prednisolone is both an immunosuppressant and an anti-inflammatory. It works two-fold by weakening the immune system to stop it from attacking the body and to help reduce the inflammation that the attack has caused. RA is a chronic condition. There is no cure so what you are seeking to do is find a level of medication that keeps the immune system in check, doing what it should do, protecting the body not attacking it. Prednisolone is a very powerful and useful drug but can and does damage the body in other ways so finding the lowest dose you can take to keep the RA in check is a good idea.
I do not have RA but I do have Ulcerative Colitis (another auto-immune condition) and learned the hard way that too fast a taper causes extreme fatigue and bone pain and a return of symptoms around the 15-10mg mark so I am speaking from my own experience. Others may have different experiences and opinions on what to do.
I hope this has been helpful and wish you good luck.
morgan51636 cjb106
Posted
Thank you, cjb106. Your reply was helpful. I didn't know that about the percentages before. I'm really hoping that I can go back to my previous dose, as Eileen mentioned above. I'm desperate to get off of this medication as quickly as possible as it's done nothing good for me. As I told Eileen, I'd much rather tolerate the RA issues rather than the horrible withdrawal symptoms I'm experiencing with Prednisone. Do you have any suggestions on how to relieve some of those symptoms as I taper back down? I don't think I'll be able to avoid them entirely so any ways to gain some sort of relief so that I can make it through the work day would be great.