TAPERING PREDNISONE. . . .m

My technique is different for different individuals. I don't believe that one should lower the dose in an uncompromising regimented fashion in the rheumatic diseases. Each person and their disease is different...

I avoid getting into the situation of mega-doses for my patients unless they have systemic organ disease involvement i.e. cardiac/pulmonary/vasculitis etc...

Therefore rule 1 - For joint disease.. I avoid doses >10 mg ....unless clinically required.

Once I am reducing down from 10mg, I reduce by 2.5 mg at a time - but slowly..

Each reduction is done in a stable clinical state , with the joints showing as little swelling as possible.

Nearly all my rheumatoid arthritis patients are on DMARDS - disease modifying antirheumatic drugs, which enable me to do this.

This may mean 1-3 months or more between reductions if so required.

i.e. on average

10mg/day 2 months

7.5 mg per day..

5 mg /day..

2.5mg per day...

Sometimes I even use an alternating dose i.e. ....7.5mg alternating with 5mg/day or 5 mg alternating with 2.5mg/day

Once I am at 2.5mg.. I start to go..

2.5mg alternate day..

2.5mg every 3rd day..

2.5mg every 4th day....etc, etc.

If at any stage the patient flares ---I go back to the previous level and retry from that level in a structured but individualized manner