Prednisone Isn't working

So i was prescribed prednizone 20mg and after 7 days, I did a blood test to see how my inflamation was. Before the prednisone my sed rate westergren was at 41. After the prednisone my sed rate westergren was at 52. Has anyone else experienced this? The rheumatologist said that if the prednisone isn’t working that a chemotherapy pill won’t work either. I just want to get back to at least almost normal. My foot has been swollen for weeks. My neck has been so stiff the past 2 weeks and it hurts to move it. Idk what to do or what my doctor will do. Im a little nervous. I still wake up with burning sensation all over and pain all over. Especially my lower back and hips when I wake up. Sometimes it only lasts a few hours and sometimes it lasts all day. I have changed my diet and am eating more fruits and vegetables than I did prior to being diagnosed. What should i do when nothing else is working or gelping?

That’s an interesting situation. I have never actually heard of that connection, that if the prednisone isn’t working that Methotrexate won’t either. My main question is whether one week was enough. 20 mg is not a crazy high dose. And is that 20 mg a day or was that a dose pack where you start at 20 mg and then go down.

It was 20mg per day for 7 days.

Thats the message he delivered to me.

Huh. I will be interested to see what some other input that you get is. I’m a bit baffled.

How does the doctor explain your elevated sed rate in the first place? When you say

Are you talking about burning such as in tendons? Or more of a neuropathy type pain? It sounds like you’re talking more about joint pain, or at least musculo-skeletal pain.

So like when I wake up, my whole body feels like its burning from the inside out. And the pain is in my hips, elbows, knees, hands, and feet. And my neck is stiff. I cant move left, right and up. And I get this pain under my shoulder blade. Idk what neuropathy is.

And he doesn’t explain the inflamation. I keep asking him and all he says is to address it to my primary care provider. It makes no sense to me.

So here’s a question for you. Are you willing to seek a second opinion? Even if everything this doctor is saying is 100% right (which I have no way of knowing), his style sounds like a poor match for you.

I have tried to make appts with other doctors but they either are not taking new patients or are not open due to covid. I guess I just stay with my pain till all of this is over.

Your situation sounds desperate and for good reason. There is a lot of combined knowledge here (Not me) but I think those who might be most helpful need a bit more history to connect the dots. I suspect there is more to your story with all this. How/when did it start? What other meds have been prescribed? My bit of experience says that a much higher starting dose of prednisone is more typical. I hope you find the help you need! Welcome here!

The more typical dose of pred for PsA starts at around 30mg. And in one way your doctor is right you ought to feel a lot better on them, even on 20mg. I’m not sure about your burning pain though. Does it feel like a internal friction burn type pain, the friction burn being the the type of thing we did to each other other as kids in the playground? If so that’s how I describe my joint inflammation.

I think you need a second opnion though. As this doctor is simply not explaining your inflammation rates just anyway. Has he physically examined your joints, as in felt them for himself? There’s a whole more to diagnosing PsA than having a decent positive reaction to pred and having high inflammation rates. It starts with your history and a physical exam and xrays to see if any joints are showing any damage.

My understanding is that response to steroids can be a good indicator of whether or not autoimmune disease is responsible for the inflammation and therefore of whether or not the usual meds would be appropriate.

However this is a complex area, my understanding is just that - a limited understanding, not knowledge. I’m trying to recall how long it took steroids to get my inflammation down, which they did. I’m pretty sure it was a fair bit longer than 7 days. That would be my main question to the rheumatologist: ‘have I really been taking prednisone long enough for it to act as a diagnostic ‘test’?’

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I would definitely keep searching for a new doctor. This one does not sound like a good fit at all. Are you taking any other medications with the prednisone? Maybe something is interacting and causing that burning sensation. I get a burning sensation in my wrists but it’s when my fibromyalgia is flared up.

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