Prednisone Blast

I know prednisone has been talked about in other posts but I’m just wondering if some of you can share your experience of using about 25mg as a prescribed 4 day “blast” to try and reset inflammation issues? That’s what my rheumy has prescribed for me to do and then he will reevaluate the effectiveness of Rinvoq. Is this a fairly safe way to go and is this a common method for others? I haven’t been on prednisone for a few years and it was for a long term and much higher dose, then weaned off slowly. Also, my rheumy would rather I got the injection form than the oral 25mg…but because I’m not very close to his office he said to go with the oral.

I actually don’t know about the ‘resetting’ of inflammation thing. Or in otherwords I don’t think pred resets anything in that way. It’s used like that for IBD stuff but for much, very much longer periods of time as in 6 to 8 months but with PsA, it masks symptoms for so long as you take them. And then the symptoms are there again when it stops. Often as you know with a kickback too, but the kickback tends to happen more when you’ve been taking them longer than 4 days.

It’s not something I would do now this long into PsA. Unless my symptoms were excessively disabling and then it would be for far longer than 4 days too. Otherwise I can’t see the point at all. It won’t help any evaluation of any med because it distorts completely how the med works. If an evaluation of how the med works needs to take place, then it must be without pred to get an accurate evaluation, otherwise it’s likely that the med will be found to be ‘just fine’ instead.

You’ll feel good symptom wise for 4 or 5 days but that’s about it. It’s not a course of treatment that makes sense to me at all.

Thanks @Poo_therapy, I agree with your thinking about "resetting " with pred. My GP and the rheumatologist both used the term recently and it seems like it’s something to do while scratching their heads. I will have my first in person exam in 19 months with the rheumatologist on June 1st. The short blast of pred is likely being prescribed to give me a break. Because the pain in multiple new joints has been slowly increasing, my tolerance has been increasing and I’m probably in more pain than I realize. If I went from no pain to this all in one step, I’d likely be flat out non functional. I took one 25mg pred two days ago and felt pretty good relief but all those other negative effects were creeping in with an inability to sleep being the worst. It’s like being jacked up on strong coffee. I think I’ll just stay on my routine of Tylenol Arthritis (2x650mg slow release) and Celebrex until I see the rheumy in a month. With spring here (finally!) the demands for much yard work are yelling and I tend to overdo things and pay for it. It’s that old stubborn nature to get mad at PsA and “I’ll show you what I can’t do!!” attitude. Kind of satisfies in the short term…like prednisone! I am having trouble admitting that Rinvoq may not be my last med but was sure hoping it would be. It’s so easy to take and side effects minimal.

Ask your rheumy to consider Cosentyx or Talz. Cosentyx has been by 5th med. We do only get so much time on one med before changing and that if they work. The beauty about Rinvoq is that you can go back to that one later again if needs be as you don’t grow antibodies to it like you can do to biologics. Something to keep in mind too.

My rhuemy recently put me on a medrol pack, as tremfya did not work after 14 months. I was in severe pain everywhere. It took the edge off while i got approved for xeljanz. I would do it again with the pain i was having.

Prednisone is one of the only thing that gives me relief. However, it has now given me avenous necrosis which means it killed the capillaries feeding blood to the cartilage in my hips. The cartilage died. My hips became bone on bone. I’m currently on FMLA and have been for nearly 2 months as I wait for my biologic to get out of my system so I can have joint replacements in both hips. I am only sharing my sorry as a cautious tale that COULD happen. Just be mindful of how often you use Prednisone.

Amos, SO sorry to hear your current state. It’s beyond :tired_face:, I know!

I agree with Poo that pred will ‘reset’ anything (don’t you wish it were true!) But that said, and keep in mind I’m not a big proponent of steroid use in general, I have had the Medrol packs on several occasions. Of course I feel like a million bucks when they kick in and of course over time I go back to my normal level of feeling like 2 cents but, for me at least, it seems to interrupt the escalating pain. Definitely not a long term solution and MOST definitely not a drug I would recommend using long term. But it might take the worst edge off for awhile and help calm things down a bit. However, if you have really undesirable side effects it may not be an option you want to pursue. I seem to have a bizarre drug tolerance (a particularly unfortunate attribute when one needs serious pain control) so other than making me flush like I’ve been sunbathing for hours on a beach in Hawaii it pretty much makes nice with the rest of me.

Hope you get some answers. :pray:

I’m so sorry to hear that. I have a friend who developed avascular necrosis due to years of Prednisone. She needed her hip replaced as well.

I’ve always been cautious about steroid use over time, but sometimes it is a necessary evil

My rheumy has me do a Prednisone blast maybe once a year or so for 7-10 days when I’m having a flare and pain in certain joints. It has helped me immensely and to avoid painful injections into joints (wrist, shoulder, hand).
Love it. No adverse side effects other than I feel slightly agitated by the 7th-10th day.

Glad it works for you so well and thanks for sharing a bit of your journey.

I spoke with my rheumy and he listened well and said I should go ahead and do the 4 days @ 25 mg of prednisone. So I got my latest blood work done for him, had an eye health appointment, (I passed) and this morning took a dose of the prednisone. It is so effective I’m depressed! No not really but how can something make you feel so close to normal and be so bad for you? I haven’t had energy and an alert mind like this for 3 years! I still have considerable stiffness but the crippling pain is almost gone and I can go up the stairs quickly. I bounce out of my chair instead of being bent and hobbled until I get going. I even chased my grandkids this afternoon. Maybe pred is just meant to be a holiday from the pain and not real life. So I will do 3 more days as instructed and see where I end up. So far, any xrays, ct’s and MRI’s consistently show little or no bone/joint deterioration…all my pain etc seems to be enthesitis related and the pred puts up an effective block. I’ll let you know how it goes and if a crash is around the corner. Yesterday night I had to crawl up the stairs on all fours cuz my knees, hip and feet were so bad. Tonight I want to go for a brisk walk…What a roller coaster!

That’s quite the roller coaster.

I will occasionally give myself little holidays with a few days of anti-inflammatories. I get it. It’s not the energy boost that prednisone gives, but if I’m sleeping well, it may as well be the same energy boost.

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I have a crazy flare periodically-to the point that I can’t work and prednisone has been a life saver. Never heard it called a “reset”, but that is what I have experienced.
I have only done the short term run probably 8x in my 10 years. Side effect…clean house.

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Presnisone totally “resets” me with no kickback. I have done 25 mg blasts, veey effective, however, the last time I did 15 mg and it worked just as well. It may not technically reset, but it can, and does for me, break the inflammation cycle.

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Ya, “reset” probably isn’t the right term unless I’m thinking of my old computer that had Windows ME on it…I got carpal tunnel from hitting the reset button so often. :slight_smile: But there is a definite change for the better, the closest I have felt to normal in 3 years! On my 3rd day of the pred trip and it seems to peak about 5-7 hours after I take it, levels off leaving me feel great but by morning I wake up with pain and stiffness creeping back in. I’ll know more after the 4th day. Taking it early morning with 2 glasses of water seems to let me sleep better at night. The PsA is definitively working overtime to take more ground (body) but I am thankful for the mobility that I have and still accomplishing much of what I want to do. I have to remind myself that there is also the natural aging process going on that has nothing to do with Psa. It just seems that aging is accurate by the PsA issues. I thought my wife was calling “stupid” the other day (likely with good reason). but she meant “stooped”. Pain has a way of trashing one’s posture!

The term I am familiar with is “Burst” It is very much in favor withe the younger Rheumys 40mg for 5 days for what is clearly a flare (as opposed to active disease. It is a reset.

FWIW I am of a certain age and a big fan of the burst. Disease progression is no longer as much a concern as is immunosuppresion. Were I 20 years younger I’d look at it differently. But for the most part a Burst every 6 or so weeks is adequate. (For now) Don’t miss lost days from the infusion center needle pokes or the MTX a bit…

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Burst sounds right but it has been a blast being on prednisone again. I am 48 hours “clean” after 4 days @ 25mg. Well, it still works as well as ever! The 4th day was the best and I moved through the day with little to no pain. I took advantage of the moment and got a ton of yard work done that I was going to hire out ‘cuz I was so sore 7 days ago that I couldn’t sleep and had to take the stairs one at a time. Incredible how effective the pred is at dealing with inflammation…it really shows that I have little joint damage, it’s all inflammation. The first day off I experienced a slow decline in freedom of movement and the joints that I probably overused were all beginning to ramp up in pain. The second day off of it is substantially worse and some new pain developing in certain fingers a toes. But I am not anywhere near as bad as I was before going on the pred…yet. Conclusion: I guess I report to my rheumy in a few weeks and he will decide to A. change meds. B. stay on Rinvoq and prescribe prednisone as needed (he prefers the injection over the pills) C. Stay on Rinvoq and add another biologic to the mix. I was thankful for being able to see how strong and capable I am to do a lot of physical stuff and wish a little pill would keep me at that state of wellness but it looks like back to the drawing board!

If nothing else it’s been so useful to you to see that there’s little damage and it’s all inflammation. It sounds like therefore you need a change of med. Incidentally the steroid by injection did nothing whatsoever for me but steroids by tablets always did. Something to keep in mind.

I don’t believe you can ever take two ‘biologics’ as in your (C) idea above. Doubt our bodies could cope with that at all, given they individually target different things. You can add two cDMARDS together like mxt and sulfasalazine etc as they are targeting the same thing. Biologics are different as they try to only manipulate a teeny part of the T-cell. And most of them differ in which teeny bit.

Thanks for the reminder re:2 biologics. This PsA is consuming way too much of my attention. I’m bored with it all but pain keeps demanding attention. It’s like a two year old throwing a tantrum when it doesn’t get its way.


That is the classic definition of PsA. And one I’ve used often. The only way to have PsA is take up less of your time, is to continually ensure you’re optimally treated. As in be an assertive patient. Often very assertive.

You’re far too ‘nice’ and accepting of what your rheumy says. Sometimes as a patient you simply have to say ‘sorry sunshine this med is working good enough, so next med please?’