Posted 12/27/2018 8:43 AM (GMT -6)
Until you undergo specifc HPA axis testing and the ACTH challenge test it would be misguided to make a sweeping change to Actemra.
Your prior diagnose of psoararic arthritis may, in fact, be an inaccurate listing from the get-go. That is, you may have more accurately been in early stages of adrenal insufficiency that was not detected and a more readily familiar diagnosis of PA applied.
Until you have fully vetted yourself with a competent endocrinologist, I would stay the course with your prednisone. If you can taper down from 10 mg prednisone to 7.5 mg per day, that would be to your betterment but your body may not allow or it may complain bitterly. If not, try to stay at 10 mg a day as a maintenance dose.
Given 10 years of exogenous dosing with Prednisone, the likelihood of your pitutary gland being to reboot and secrete sufficient ACTH for maintenance let alone stress buffering is low to nil. The HPA axis coordinates life essential cortisol via highly sensitive negative feedback loop with the adrenal glands. This is not a system that takes well to disruption. It is the equivalent of a computer’s critical software.
Bottom Line: You will likely be corticosteroid dependent. Ad hoc directives from the physicians who have provided you with prednisone for all of these 10 years who are now concerned with your inability to taper and reactively suggesting you need a prednisone free alternative are not owning their lack of clinical knowledge of the endocrine effects of prednisone. They have ownership in your plight as well. A wide pendulum swing to a prednisone sparing drug at this point is both unwise and foolish until you have been fully evaluated and counseled by an endocrinologist with HPA axis speciality.
This is not a trivial matter, as I know you understand.
Keep in touch with me.