Input needed about pred and vax

I had to email my rhuemy last night because I was in so much pain. I asked him if he felt the 2nd Pfizer vax I got 12 days ago would have triggered a bad flare. The answer was of course, “maybe.”

He said I am far enough out from the 2nd dose that I can do a prednisone Dospak.

Any opinions on how this may effect the efficacy of the vax?

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My understanding is that what your Rheumy is saying is correct. Anitbody production is within 2 weeks of dose 2. PERHAPS in your case it would be worth doing an antibody assay before starting the Predi???

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I was told by my rheumy, “I do not want you any steroids at all 7 days before and 7 days after covid vaccination or shingles vaccination”.

I had to wait and go with the DosPak. I waited two more days until I was 15 days out from 2nd Vax. I was consumed with pain. The 2nd dose of vax really seemed to cause my PSA to flare very badly. May not happen to everyone, but it did me. Rhuemy agreed vax probably set it off. Pred DosPak is a pain trade off for me. I am one of those lucky people that Pred makes my low back hurt. But, my ribs, legs and hips hurt so bad I started the pred. The flare is getting better, but now I am down from the low back pain. Can’t win.

First have you ever been tested for covid-19 antibodies, if the answer is no, do so immediately. Covid-19 is associated with an increase in Cytokines which in your instance would translate into less efficacy of a glucocorticoid such as prednisone.

If you are on a high dose of a glucocorticoid, such as prednisone, it is extremely likely that the mRna antibody production would be inhibited, which is likely since both the Moderna and Pfizer are small molecule drugs (mRna) encased in a peptide.

I would really like a medical explanation as to how a small molecule drug leads either to (1) the activation of B-cells, or G-proteins, due to activation of HPT receptors, or (2) a hypothesis of a non-covid related cytokine syndrome related disorder.

I’m a little confused as to your use of some terminology can you elaborate?? HPT receptors refer to hematopoietic stem cells who travel to the bone marrow . There, they begin to produce new white blood cells, red blood cells, and platelets in a process known as engraftment. White Blood cells of course move all kinds of proteins around to create an immune reaction. mRNA*display is a display technique used for in vitro protein, and/or peptide evolution to create molecules that can bind to a desired target. The process results in translated peptides or proteins that are associated with their mRNA progenitor via a puromycin linkage. The Covid vaccine is mrna is encased in a lipid which is nonactive commonly PEG2000-DMG. A Peptide bond is present in proteins, not in lipids or nucleic acids. What confuses me about your question is that(very simply put)messenger RNAs (mRNA) are the set of protein-building instructions that can move from the nucleus of the cell to the cytoplasm. mRNAs are created as an exact copy of the segment of DNA found along the genome corresponding to a protein-coding gene. Unlike DNA, the mRNA can move from the cell’s nucleus to the cytoplasm. Once inside the cell’s cytoplasm, the machinery responsible for building proteins, called the ribosome, reads the mRNA and gets to work making proteins. After the mRNA is read and the building process begins, the mRNA is quickly destroyed by the cell. Destruction of the mRNA ensures that the cell does not make too much of one type of protein. mrna is VERY specific and dosn’t have a life of its own (unlike DNA which it is a part of sort of like capiscan in a pepper) So I am not sure what process you are refering to. Small molecule refers to chemistry. A long chain is single bond of the atoms short chain is several bonds (also called large and small molecules chain)

Steroids (in amounts over 10mg) are by nature immunosuppresent, thats why people take them. How that effects a particular individual is unknown ony one small study has been done and that was essentially inconclusive. Based on a small study of 133 fully vaccinated individuals taking immunosuppressive medications, antibody levels and virus neutralization was three times lower than in individuals not taking these medications. The study has not been peer reviewed. However, study coauthor Alfred Kim MD, PhD, Assistant Professor, Division of Rheumatology, Washington University School of Medicine noted in an interview with Reuters that, “most patients in the study were able to mount antibody responses in response to SARS-CoV-2 vaccination, which is reassuring." So practice has been to hold off a couple weeks to be sure. A flare or other “reaction” to the second dose is actually considered “good nes” (unless you the one having it) as it is evidence of your immune system going to work. But again with all the said I just don’t understand your question. You seem to have a lot of bits and pieces run together in a way I don’t understand - sorry…

I guess I had good news then! :slight_smile: I sure had a bad flare starting about 4 days after the second one. Thanks for the info.

I apologize, I made an error I intended to refer to 5-HTP >>> B Cells >>> G Protein, which is basically the inflammatory process that people with Psoriatic conditions suffer from. The M-RNA vaccines create B-Cells with a specific structure that binds with Covid-19. In this setting the m-RNA vaccine is simply not self replicating, otherwise we would not question how long the vaccine is acutely effective.

IF the question is if glucocorticosteroid use is less effective in treating the psoriatic inflammation due to the transcription of the B-Cells required to confer some degree of immunity to Covid-19, I would say it is a reasonable hypothesis, that would be transient in nature.

Not quite 5-HTP is an amino acid supplement used (supposedly) jump start serotonin. 5-Hydroxytryptophan (5-HTP) is the intermediate metabolite of the essential amino acid L-tryptophan (LT) in the biosynthesis of serotonin. Intestinal absorption of 5-HTP does not require the presence of a transport molecule, and is not affected by the presence of other amino acids; therefore it may be taken with meals without reducing its effectiveness. Unlike LT, 5-HTP cannot be shunted into niacin or protein production. Therapeutic use of 5-HTP bypasses the conversion of LT into 5-HTP by the enzyme tryptophan hydroxylase, which is the rate-limiting step in the synthesis of serotonin. In Psoriatic Arthritis . Regulatory B cells(Breg cells) producing IL-10 (B10 cells ), a critical anti-inflammatory B - cell subset, were found to be decreased in both PsA and psoriasis. Thats whereApremilast, sold under the brand name Otezla came from. Not sur ewhat you mean by G protein. G-protein coupled receptors are consistenty found in patients with persistent post-COVID-19 symptoms. Its allows things to be absorbed through the cell walls.

How are you doing now? You’re done with the dose pack and hopefully feeling some relief?

Finished the DosPak. It helped my rib pain is way down along with the all over pain, but now my back is shot. Pred makes my low back hurt, so it was a trade off. I getting worried that I may have the beginning of AS in my back. I’ll find out in a few weeks.

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So some positive results, but not completely. That’s interesting that the prednisone makes your lower back hurt. Do you have any idea why that is?

Hopefully it’s not AS, but even if it is, you’re certainly in the right treatment area already so it’s a good start. What sort of imaging are you having done?

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Low back pain is one of the rare side effects of pred. I’m just lucky.

That stinks. I probably would know that if I read more about side effects, but generally speaking I try to avoid reading about them. I’ll only watch out for the most extreme things, that my doctor May mention to me.

I learned about the low back pain many years ago. When I used to get bronchitis, my doctor decided antibiotics were not working, so DosPack. Every time I get bronchitis, he went straight for the Dospack. It turned into pneumonia few times, so he stopped trying antibiotics. I have some severe allergies too, so I get it for those too. I try to avoid it now if possible. Rheumy put me on 5 mg pred a day for the PsA. I struggled with it for about 6 months, but had to get off because of the back pain.

My body feels better now after the severe flare from the vax, but my back is in terrible shape. I’m not sure the trade was worth it.

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I can identify with how disabling back pain can be. I’ve lived with a severely herniated disc at L5/S1 since my early 20’s.
@tamac, have you had a recent MRI and conclusive diagnosis? Treatment of back issues is so dependent on accurate diagnosis and it can be easy to assume one thing and it ends up being something entirely different. I’m currently struggling with terrible knee pain that is assumed to be from the PsA but am pursuing the possibility of other causes.
I know that retirement is on your horizon but with so many issues it can be difficult to look forward to more pain. We all want to retire to a quality of life that is reasonably pleasurable. I pray that you can hang on to small victories and glimmers of hope.
I don’t know about others but I have found that there is some sort of correlation between my back pain and stress in my life. Worry and stress seem to amplify physical issues. And most of my stress tends to be self induced. Hang in, ponder good things…somehow joy is closer than we think even when pain is persistent. Joy and pain can coexist but it doesn’t come easy.


I can’t have MRI’s, I have a Vagal Nerve Stimulator for depression. CATs are all I can have,

I am going to have my rheumy check my low back next visit.

I know all about bad disc. Most of my neck is fused, thanks to someone playing with their cell phone. C5, C6, and C7 were fused in 2005. C4 and C5 were fused in 2008. C2 and C3 had osteophytes removed in 2012. They have now fused on their own. C6 and C7 were refused in 2013, the bone graph had failed. In 2013, they put in 2 rods, and 8 post (plus the original 2 plates and 15 screws) to make sure nothing ever moved again.

C3 and C4 are the only pair that still move (plus C1). They need to be fused, but my doctor said he just didn’t think it would be the best outcome. So, now I get an an epi in the neck every 4 or 5 months.

I had two major fusion surgeries and prostatectomy for caner in 18 months during 2012 and 2013. Doc said that was probably what turned on the PsA. I am hoping it is not AS.

I think a lot of my back problems now are from no exercise and an extra 50 pounds I am carrying. I must do something about both of those problems.

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Oh man! I think it is pretty amazing that you have been as capable as you have been given your many trials. I hope you find success in pursuing the things that you need to do to help and that your rheumy pays close attention

Speaking of Predi (from one of our other communities:


Here is a link that was included in a discussion about combining corticosteroids with the covid vaccine. A very interesting read.