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What You Need to Know About Prednisone for Psoriatic Arthritis

Managing PsA

November 30, 2023

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Photography by FG Trade Latin/Getty Images

Photography by FG Trade Latin/Getty Images

by Stacey McLachlan

•••••

Medically Reviewed by:

Alexandra Perez, PharmD, MBA, BCGP

•••••

•••••

by Stacey McLachlan

•••••

Medically Reviewed by:

Alexandra Perez, PharmD, MBA, BCGP

•••••

•••••

Prednisone is a bit of a power player in the world of psoriatic arthritis treatment. It’s a versatile steroid drug that’s a go-to for doctors.

Prednisone is a synthetic compound that mimics the effects of hormones your adrenal glands naturally produce. This versatile steroid is designed to tackle inflammation and immune system imbalances, which means it’s a helpful option for many people living with psoriatic arthritis (PsA).

Of course, like any drug, prednisone has benefits and drawbacks. So, if you’re considering incorporating prednisone into your PsA treatment plan, here’s everything you need to know before you get started.

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What are corticosteroids?

Corticosteroids are a class of drugs with potent anti-inflammatory properties. Doctors prescribe them for a wide range of conditions, from asthma to autoimmune disorders.

Prednisone is an oral corticosteroid commonly prescribed to people living with PsA. The drug disrupts your immune system to help block chemicals that cause inflammation.

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Why prednisone may help with PsA

If you’re living with PsA, you’re well aware that it causes inflammation in your joints, leading to pain, swelling, and stiffness. Prednisone may help treat these uncomfortable symptoms in the following ways:

  • Anti-inflammatory properties: When you have PsA, your immune system mistakenly attacks your joints, causing inflammation. But prednisone can help suppress this immune response and reduce that inflammation. The result? Relief of symptoms in the affected joints.
  • Immunosuppression: PsA involves an overactive immune system that attacks healthy tissues. Prednisone acts as an immunosuppressant, modulating your immune response and preventing your immune system from attacking your joints. In a best-case scenario, this reduces the progression of the disease and helps you manage your symptoms.
  • Pain relief: Prednisone can help relieve pain associated with PsA. By reducing inflammation, it can help alleviate joint pain and discomfort, allowing you to experience improved mobility and quality of life.

But while prednisone can provide significant relief, it’s generally used as a short-term solution because of the risk of side effects associated with long-term use. (More on that below.)

Typical dosage

What’s the typical dosage of prednisone for people living with PsA? As you can probably guess, the answer varies depending on the severity of your symptoms, your overall health, and the rest of your treatment plan.

Prednisone is often prescribed as a short-term solution to quickly manage inflammation and symptoms during flare-ups. Typically, the initial dosage of prednisone for PsA ranges from 5 to 60 milligrams per day. It’s common for the initial dose to be higher during the acute phase of inflammation, with a gradual tapering to a lower maintenance dose as symptoms improve.

Healthcare professionals generally avoid prescribing high doses of prednisone for long-term use due to the risk of serious side effects. The goal is to find the lowest effective dose that relieves symptoms while minimizing the potential for negative reactions.

Your doctor may prescribe disease-modifying antirheumatic drugs (DMARDs) or biologics in conjunction with prednisone to help manage your PsA long term.

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Side effects of prednisone

Like other corticosteroid medications, prednisone can have a range of not-so-great side effects. The severity and likelihood of these side effects can depend on the dosage, the duration of use, and individual factors such as age and overall health. Here are some common side effects associated with prednisone:

Short-term side effects (which usually occur with higher doses or prolonged use):

  • increased appetite and weight gain
  • fluid retention
  • elevated blood pressure
  • mood swings and changes in behavior
  • insomnia
  • increased susceptibility to infections
  • increased blood sugar levels, which can increase the risk of developing or worsening diabetes
  • osteoporosis (thinning of bones)
  • muscle weakness

Long-term side effects (which are more likely with prolonged or high dose use):

  • cataracts and glaucoma
  • skin thinning and easy bruising
  • adrenal gland suppression, which may lead to adrenal insufficiency when stopping the medication
  • redistribution of body fat, which can lead to a “moon face” appearance and increased abdominal fat deposits
  • decreased growth in children
  • menstrual irregularities
  • gastrointestinal issues such as stomach ulcers and pancreatitis

Abruptly stopping prednisone after prolonged use may result in a flare-up, with withdrawal symptoms such as fatigue, weakness, joint pain, and muscle stiffness. That’s why it’s important to taper off of prednisone with medical guidance.

Other potential treatments for psoriatic arthritis

Prednisone is just one of many options available for people living with PsA. You can talk with your healthcare team about other potential treatments, which may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can help reduce pain and inflammation.
  • DMARDs: DMARDs, such as methotrexate, sulfasalazine, and leflunomide, can slow the progression of joint damage.
  • Biologics: Biologic medications, including tumor necrosis factor (TNF) inhibitors (such as adalimumab, etanercept, and infliximab) and other targeted therapies (such as ustekinumab and secukinumab), are designed to target specific pathways in your immune system that contribute to inflammation.
  • Corticosteroid Injections: For localized joint inflammation, healthcare professionals can inject corticosteroids directly into the affected joints to provide rapid relief of symptoms.
  • Physical therapy: Exercise and physical therapy can help improve joint function, reduce pain, and maintain mobility.
  • Occupational therapy: Occupational therapists can provide adaptive techniques and tools to help you manage daily activities and reduce strain on your joints.
  • Lifestyle strategies: Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and stress management, can contribute to your overall well-being and may help you manage PsA symptoms.
  • Topical treatments: For skin involvement in psoriasis, healthcare professionals may prescribe topical treatments such as corticosteroid creams, vitamin D analogs, and retinoids.
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Takeaway

Prednisone is a potent corticosteroid that can serve as a valuable tool to relieve inflammation, reduce pain, and improve overall joint function during PsA flare-ups. But this powerful medication comes with some potential side effects, especially when used in high doses or for a long time.

If you’re considering incorporating prednisone into your PsA treatment plan, talk with your doctor and proceed with caution.

Medically reviewed on November 30, 2023

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About the author

Stacey McLachlan

Stacey McLachlan is a writer, editor from Vancouver, B.C. specializing in design, food and travel writing. She earned her BA in Communications from Simon Fraser University and is editor-at-large for Western Living and Vancouver magazines. Stacey is a regular contributor to Dwell and has been published by the Globe and Mail, Montecristo, and Healthline, among other outlets. Find her on her website.

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