A spirited debate was published in the Rheumatologist, a magazine I get. The topic was the use of prednisone in rheumatoid arthritis. Recent guidelines produced by the American College of Rheumatology regarding treatment of rheumatoid arthritis omitted the use of prednisone.
Dr. John Kirwan, a professor at the University of Bristol, who wrote several papers showing that prednisone had disease-modifying effects and held back the destructive processes of rheumatoid arthritis (RA) made his pitch. He advocated the use of prednisone in combination therapy for this condition.
Dr. Theodore Pincus, a professor at NYU, advocated the use of low dose prednisone (less than or equal to 5 mgs a day). He provided evidence that it was safe and effective at that dose.
Dr. Anthony S. Russell, a professor at the University of Alberta issued the counterpoint. He provided historical data showing that prednisone had long term toxicity without significant benefit (in his opinion.)
With all due respect to Dr. Russell, much of the data he cited was old data when higher doses of prednisone were used. He also contended that primary care doctors would be tempted to use prednisone if they saw rheumatologists using it.
My opinion is this. I use low dose prednisone a lot in my practice. By low dose, I mean 5 mgs or less. I think it is effective as an add- on therapy. It is also a great “bridge” if the patient is transitioning therapies. I have seen very little long term toxicity associated with this low dose approach. And I think the benefits derived from improved activities of daily living far outweigh the negatives. I do think that doses higher than 5 mgs should be avoided if possible. I also don’t think the primary care issue is that big a deal although I admit… I have seen some indiscriminate use in my community.
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