Treatment plan ?

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Veteran Member

Date Joined Jan 2004
Total Posts : 598
   Posted 6/6/2008 4:21 AM (GMT -7)   
 I called my rheumatologist with a report of how I did on the 10 day prednisone trial.  His nurse called back and said that he was starting me on 10mg prednisone daily and she made an appt for next week to discuss "treatment options".  My last appt he mentioned methotrexate or immuran.  Would it be common to start a person on a low dose of prednisone before starting one of these meds? I'm curious to see what a low dose of pred does for me.  I relapsed when I tapered from 30mg to 20mg but then when I hit 10mg I seemed to stabilize a little.  After I ended the trial I went back to my pre-prednisone condition, more or less.   
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin, sertraline, lyrica, 10mg prednisone, next???   

frank j
Regular Member

Date Joined Jun 2006
Total Posts : 341
   Posted 6/6/2008 5:57 AM (GMT -7)   
yes, starting one of these meds would likely be common if you can't get off pred. long term pred use causes a whole host of bone and other problems. for example, it can lead to necrosis (death) of the hip joint bone, requiring hip replacement. if you can't get off pred, it wouldn't surprise me if they want to get you started on metho/imuran before weaning from pred since it takes time for either of these drugs to build up in your system and to become effective. also, this allows the doc to start you slow on these meds to first make sure you're not allergic before upping the dose to an effective level. so... the plan (though with very limited information) does not sound unreasonable on its face. good luck...

Crohn's 4 ever
Regular Member

Date Joined May 2008
Total Posts : 207
   Posted 6/6/2008 6:21 AM (GMT -7)   
Frank is right, weaning is always a good idea, all drugs take time to be in affect. I was on Methotrexate for about 4 months and didnt work for me, all I got was migrains, and I dont even get headaches. Everyone reacts different to different combo's too. I am on Humira, and hoping for remission, had crohns almost 30 years and not too many remissions, only 1 for 6 years after first surgery and I had a reaction to Immuran, I am not good with meds for some reason, Remicade put me in the hospital, so Humira is my last resort. Good luck, I am sure you will do just fine!

Regular Member

Date Joined Feb 2008
Total Posts : 91
   Posted 6/6/2008 8:23 AM (GMT -7)   
Weaning is always good...and some doc's do it before placing a person on other meds for maintanence. Prednisone is a good drug to be hated. It works well to get everything under control but as a maintanence drug it is dangerous. I deal with CD, AS, Asthma and Uveitis all of these disorders use prednisone to take down the inflamation. When the doctors manage (if they do) to get my inflamtion down they then will add other drugs. Right now I am on methotrexate and have found it to partly working. They wont re-introduce prednisone because my hips are thinning (compliments to prednisone) and they need to find out the total distruction of my hips.
CD diagnosed 34 years ago
Stem Cell Transplant may be back on
Lap-assisted Ileocolic Resection- February 2008
Ankylosing Spondylitis
Back on Prednisone - I hate it
Ranitidine HCL 
Prednisone 1% (eye drops)
Maxidex  (eye ointment)
Homatropine 5% (eye drops)
B12, Folic Acid, Vitaman D, Calcium

Veteran Member

Date Joined Jan 2004
Total Posts : 598
   Posted 6/7/2008 5:29 AM (GMT -7)   
Thanks for your responses. I guess you could say I can't get off prednisone in that my pain and malaise returned when I weaned off it. I only took it for 10 days. It was a trial to see if I responded to it or if my foot pain was a mechanical problem. The surprise was that it also made my gut feel so *normal*. I thought it was good before on pentasa. When I called with my report how the 10 days went, he started me back on 10mg and made an appt for this coming Friday. I notice he wrote the prescription for 3 refills so it looks like he plans to keep me on prednisone for a little while. At the first visit he mentioned methotrexate or immuran so I guess that is what he is planning. He said you have to fail the iv meds first before you can go on remicade or humira (unless you have some other feature of CD like fistulas etc) The joint inflammation would qualify me even if my gut doesn't. However, I know some have been on these Big Guns without first being on methotrexate or immuran. There is no standard protocol. I'm not anxious to start on these two so I am willing to try the immunosuppressants. I have some complicating factors such as my WBC count which is already low (2200-3600) reason unknown, have had a workup with a normal bone marrow. The rheumatologist suggested the drop in my WBC count (its always low but never as low as 2200) could be due to pentasa as it happened about 1 month after I started the drug.
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin, sertraline, lyrica, 10mg prednisone, next???   

Veteran Member

Date Joined Dec 2007
Total Posts : 2113
   Posted 6/7/2008 5:53 PM (GMT -7)   
My rhuemy kept me on pred while first plaq then mtx started working. It takes months for those drugs to work fully-though I had wonderful results from mtx at only four weeks. I am weaning off pred now my doctor told me to go down to 2.5mgs from 5 for two weeks then stop-she wrote the script for 90 pills with 3 refills-either she did not think I would be okay off the pred or she doesn't mind me having extra floating around-I will ask her which at my next appointment.
I have decided that one characteristic of a good patient centered rhuemy is supplying emergency prednisone. (I woke up one morning with so many swollen joints I had trouble just dressing myself then had to drive to the doctors (gp) office (already had an appointment scheduled for that day) beg for pred9-which she would not give me (gave me medrol dose pack) call every day for a week to be given another dose pack then got pred-) beg for a referal to a rhuemy-I did not have one at that time-then wait six weeks for an appointment with the rhuemy-so anytime she wants to write scripts for extra pred its okay with me-I even have her permission to up my dose as needed and call her afterward-that works for me. (I would never lower my dose without talking to her first).
Anyway my point was your doctor probably expects you to be on pred for at least a few months while waiting for you to decide which med you want and for it to kick in. Then he will have you try to taper off if that doesn't work he will probably leave you on pred until the next med he adds kicks in.
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