TAPERING PREDNISONE. . . .m
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|Tue, 03-25-2003 - 3:33pm|
Weaning Steroids in RA joint disease
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