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Prednisone For Gout Side Effects

The Four Stages Of Gout

Prednisone: Dosing and Side Effects

Gout is best understood by seeing it as having four phases or stages :

Stage 1: High uric acid

Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.

Stage 2: Acute flares

This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.

Stage 3: Intercritical periods

These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.

Stage 4: Advanced gout

This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .

Figure 1: Stages of Gout

Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)

Figure 3: Progression of Gout

How To Take Prednisone For Pain

Prednisone for RA is generally started with a dose of 10-20 milligrams per day and then maintained at levels of 5 mg/day or more. Patients with extra-articular symptoms such as eye or lung inflammation are more likely to be on larger doses.

The length of your treatment course will be made on an individual basis but short-term pain therapy is normally around one to three weeks.

Prednisone is available in both immediate-release and delayed-release formulations, which are taken by mouth in the form of a tablet or liquid. It is usually taken with food. When you take your dose and how often you take it will depend on your conditions and how you respond to treatment.

It is important to know that if you have been taking prednisone for a while you should not discontinue treatment suddenly as it can lead to severe withdrawal symptoms. This is because if you suddenly stop taking prednisone this may leave your body with not enough natural steroids to function normally.

Your healthcare provider will outline for you if and how the drug needs to be tapered down to avoid problems with withdrawal.

Steroid May Be Safe Effective Gout Treatment

Doctor says this appears to offer options for pain management

HealthDay Reporter

MONDAY, Feb. 22, 2016 — A steroid pill may be as good as a nonsteroidal anti-inflammatory drug for treating painful gout, new research suggests.

Researchers who compared the steroid prednisolone with the arthritis medication indomethacin found both drugs offered a similar degree of pain reduction. And while indomethacin appeared to cause more minor side effects, neither treatment prompted serious complications, the researchers said.

Smaller investigations have pointed in the same direction, said study lead author Dr. Timothy Rainer, a professor of emergency medicine at Cardiff University in Wales. But because the new findings are the product of a “larger and better-designed” effort, Rainer said steroid pills may gain standing among gout experts who usually stick with NSAIDs as their first-line treatment.

The bottom line is that there are choices, said Dr. Philip Mease, a rheumatologist with the Swedish Medical Center in Seattle.

“That is the key message — that there are options,” said Mease, who wasn’t involved in the study. “Sometimes ER docs don’t think about giving a tapering dose of prednisone, but it can be very effective at helping with gout, which can be damn painful.”

Gout is the most common form of inflammatory arthritis among men, the study team said, affecting about 3 percent of adults in the United States.

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The Role Of Physical Activity In Prevention Of Gout

Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.

How Prednisone Dosage Impacts Side Effects

Prednisone Treatment For Gout

Most steroid side effects only occur when people take prednisonelong-term. For non-chronic issues, you might take it only for a couple ofweeks.

We also try to start you on a high dose and thenrapidly lower it, which also minimizes side effects, Dr. Ford explains. Thatway, you get the benefit of a strong anti-inflammatory burst to settle down thereaction. Then the prednisone stays in your system long enough at lower levels sothe whole reaction can turn itself off.

For longer-term prescriptions, doctors may taper down dosages gradually to get them as low as possible without the return of symptoms. We typically aim for a dose thats about 5 to 7 milligrams a day, says Dr. Ford.

Were trying to roughly match how much cortisol the body produces, though many patients will be on a higher or lower dose than that.

The right prednisonedosage helps your body fire on all cylinders and reduces potential sideeffects. But if you hit a symptom sweet spot, it doesnt mean you no longerneed to take it.

Dont stop taking prednisone without checking with your doctorfirst, Dr. Ford cautions. Stopping it suddenly will likely bring back thesymptoms were trying to control.

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What Drugs Interact With Prednisone And Prednisolone

Prednisone

Prednisone interacts with many drugs, examples include:

Prednisolone

  • Rifampin decreases blood levels of prednisolone by increasing its breakdown in the liver. The dose of prednisolone may need to be increased in order to avoid therapeutic failure.
  • Corticosteroids have variable effects of warfarin therapy. Coagulation levels should be monitored more closely when anticoagulants are combined with corticosteroids.
  • Estrogens may increase the levels of prednisolone by decreasing its breakdown. When estrogens are used with prednisolone, side effects of prednisolone should be monitored.
  • Steroids increase blood sugar levels and, therefore, reduce the effect of drugs used for treating diabetes.
  • Activity of cyclosporine and corticosteroids increase when both drugs are combined. Seizures have been reported.
  • Combining aspirin or other nonsteroidal anti-inflammatory drugs and corticosteroids increases the risk of gastrointestinal side effects.
  • Combining corticosteroids with potassium-depleting agents increases the risk of low blood potassium . Vaccines are less effective in patients on prolonged corticosteroid treatment because corticosteroids suppress the immune system. Corticosteroids may also allow organisms contained in live attenuated vaccines to replicate.

When Is Prednisone Prescribed For Pain

RA primarily causes pain, swelling and stiffness in the joints. It is often a disease of ups and downs, with periods when symptoms become worse, known as flare-ups or flares. These can be unpredictable and debilitating.

Prednisone is prescribed as short-term pain relief during these periods of exacerbation and as a bridge therapy to provide relief while waiting for disease-modifying antirheumatic drugs to kick in. DMARDs are the recommended first-line treatment for RA but they are slow to work you may not notice benefits for six to eight months after starting them.

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Challenges To Implementation: No Significant Barriers

We found little to prevent physicians from adopting this practice changer. Oral steroids are readily available and inexpensive, and most primary care clinicians regularly prescribe them for other conditions. This practice change recommendation should be readily implemented.

The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.

PURLs methodology This study was selected and evaluated using FPINs Priority Updates from the Research Literature Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.

* Prednisone is the precursor of prednisolone and is activated in the liver. The activity of both drugs is comparable, and prednisone and prednisolone can be converted milligram to milligram. However, prednisolone may be preferred for patients with severe liver disease.

Are There Any Side Effects

Prednisone side effects arthritis b.wmv

Low dose prednisolone, taken for a few days or even a few weeks, does not normally cause any unwanted side effects.

If prednisolone is taken in high doses or for a long time certain predictable side effects can occur. Some of these improve after prednisolone is stopped. Many can be minimised by giving the lowest effective dose over the shortest possible period of time.

The effects may also be minimised by giving the medicine by injection into the joints or into a muscle.

Most common possible side effects

  • Weight gain: The most common side effects are rounding of the face and weight gain around the stomach. These are due to altered metabolism, increased appetite and salt retention.
  • Osteoporosis : While very low doses of prednisolone are not very likely to cause thinning of the bones, moderate and high doses taken for long periods usually cause this problem. Your doctor will tell you if you need a bone density test to check your risk of osteoporosis. To reduce the risk it is recommended that you:
  • have 1000mg of calcium each day
  • take 30 minutes of weight bearing exercise each day
  • avoid smoking and avoid drinking more than 2 standard drinks of alcohol a day
  • get some sunlight exposure each day to maintain vitamin D levels. You should wear sunscreen as usual to protect your skin from sun damage. As well as sun exposure, a vitamin D supplement may be recommended if vitamin D levels are low.
  • Trouble sleeping may also occur but can be minimised by taking prednisolone in the morning.
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    Bone Loss And Bone Death

    Bone loss may be one of the most serious consequences of corticosteroid therapy thin, brittle bones can lead to fractures. Another problem, bone death , can occur as well. Solution: Daily, weight-bearing or resistance training exercise such as walking, jogging or weight lifting is critical to keeping bones strong. Additionally, the American College of Rheumatology recommends getting between 1,000 mg to 1,200 mg of calcium and 600-800 IU of vitamin D every day some people at moderate- to high-risk of fractures may need to take osteoporosis medication. Also, quit smoking, eat a balanced diet, limit alcohol consumption and maintain a healthy weight.

    Prednisone As Gout Treatment

    What is Prednisone?

    Prednisone is a drug that is used to treat inflammation. It prevents the release of substances in the body the cause inflammation. This drug is also used to treat other diseases such as psoriasis, allergic disorders, breathing disorders, and skin allergies. It has also been used in the treatment of severe tuberculosis, thyroiditis, laryngitis, asthma, and migraine. Prednisone is also sometimes used to treat the symptoms of certain types of cancer. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.

    How should prednisone be used?

    Prednisone should not be taken by someone who is allergic to it or if there are fungal infections in the body. Before taking this medicine, one has to consult a doctor about his condition. Intake of prednisone is also not recommended for those who are pregnant or lactating. Prednisone either comes as a tablet, a liquid solution, or a concentrated solution to be taken by mouth. It is usually taken with food one to four times a day or as the doctor prescribes. It is very important to follow the prescription label of the drug carefully and take the medicine exactly as directed.

    What are the side effects of prednisone?

    Prednisone may sometimes cause serious side effects such as:

    • vision problems
    • numbness of some parts of the body
    • difficulty in breathing or swallowing
    • vomiting

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    Medicines To Prevent Recurrent Gout Attacks

    If you have repeated attacks of gout, your doctor may recommend preventive medication. This helps to prevent further attacks of gout and damage to your joints and organs such as your kidneys.

    Because gout is caused by raised uric acid levels in the blood, preventive medications work by reducing uric acid levels. This is also called urate lowering therapy.

    The goal of these medicines is to reduce the uric acid levels below 0.36mmol/L. If the uric acid level is kept at this level long-term, the gout crystals will dissolve, and the risk of gout attacks and joint damage from gout will gradually reduce. The options include:

    How Is It Taken

    Prednisone 20mg High

    Allopurinol is taken as a tablet once a day. It is usually better to take it just after eating and the tablet should be swallowed with water. It is important to drink plenty of water during the day because this will help you get rid of more urate through your kidneys.

    Your dose of allopurinol may change over time, depending on the amount of urate in your body. Your doctor will monitor your urate levels with blood tests every 2-4 weeks, until they are sure that the dose that youre taking is high enough to reduce the amount of urate in your body.

    You may need to remain on a lower dose if you have kidney or liver problems.

    Your doctor may recommend that you do not start taking allopurinol until after an attack of gout has passed to avoid triggering further attacks. If this is not possible, it may be started when your inflammation is not too bad.

    Allopurinol doesnt treat the immediate pain caused by attacks of gout. But its a long-term treatment to get rid of the urate crystals which causes gout attacks.

    It is likely that you will need to take allopurinol for the rest of your life to manage your urate levels. You should keep taking allopurinol even if:

    • you are experiencing more gout attacks, or it doesnt seem to help the pain and inflammation at first
    • you stop having gout attacks stopping your treatment can cause urate crystals to form again, which will lead to more gout attacks.
    • etoricoxib

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      How Prednisone Stops Pain

      Prednisone stops pain by reducing symptoms such as inflammation and by suppressing your bodys immune system. Inflammation is how the immune system responds to your body being harmed, such as injury or infection. In RA, the immune system attacks its own tissues and cells, resulting in inflammation and tissue destruction.

      The main way prednisone works is by preventing the production of certain pro-inflammatory cytokinesproteins that serve as messengers between cells. The overproduction of pro-inflammatory cytokines is associated with a number of chronic inflammatory and autoimmune diseases, including RA.

      Prednisone prevents the production of cytokines by binding to glucocorticoid receptorstypes of cell molecules that receive and send signals in the body. This prevents these molecules from sending signals that pro-inflammatory cytokines should be created.

      In addition to this, prednisone activates the production of some anti-inflammatory cytokines and affects the actions of certain lymphocytes called T-cells, which play a central role in the bodys immune response.

      It also acts to control how easily molecules are allowed to flow in and out of blood vessels. This reduces tissue edemaswelling caused by small blood vessels leaking fluid into tissues.

      All of this works to quickly relieve the inflammation, pain, redness, and warmth experienced during an exacerbation of your symptoms.

      Whats New: Evidence Supports Use Of Steroids For Acute Gout

      In the United States, prednisone is prescribed as treatment for acute gout only about 9% of the time. These 2 studiesthe first randomized trials comparing oral steroids with NSAIDs, the usual gout treatmentmay lead to greater use of steroids for this painful condition.

      Both studies were well designed and conducted in an outpatient setting. Both showed that a short course of oral steroids is as effective as NSAIDs, and without significant side effects.

      Previous studies have compared IM steroids with NSAIDs, and IM steroids with IM adrenocorticotropic hormone ., However, these studies were not blindedjust one of their methodological problems.

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      Dietary Changes To Minimize Medicines

      Although gout may be inevitable for some, dietary and lifestyle changes may reduce gout flare-ups and reduce the needs for drugs. Certain foods, such as red meat, some seafood and alcohol, are known to contain high levels of purines, substances in plant and animal food that your body converts to uric acid. Bhatt recommends a vegetarian, low-purine diet to decrease the likelihood of gout attacks. Low-purine foods include low-fat non-fat dairy products, vegetables, nuts and grains. He also recommends that patients maintain a healthy weight, as obesity is associated with gout.

      The Gout & Uric Acid Education Society also recommends limiting intake of fruits that contain a high level of fructose, a naturally occuring sugar, as well as cutting back on soft drinks, which contain high-fructose corn syrup. Fruits high in fructose include apples, grapes, peaches and pears. In addition, you should avoid cereals, ice cream, candy and fast food, as they can be high in sugar and salt.

      As part of the long-running Nurses Health Study, researchers looked at the relationship between coffee consumption and the risk of gout in nearly 90,000 women over the course of 26 years. It found a reduced risk for women who consumed coffee, according to a 2010 study published in the American Journal of Clinical Nutrition.

      Edwards says drinking cherry juice can decrease gout flare-ups, but patients who need a uric acid medication need to stay with it for life.

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      Pathophysiology And Risk Factors

      How to Counteract Prednisone Side Effects

      Genetic mutations may be associated with overproductionor more often underexcretionof uric acid because of defects in the renal urate transporter system.6 The prevalence of gout increases with age and peaks at more than 12% in persons older than 80 years.1 Because female sex hormones increase urinary excretion of uric acid, pre-menopausal women have a substantially lower prevalence of gout compared with men .6 Black persons have a higher risk.7 Consuming alcoholic drinks , meat , some seafood , fruit juice, and beverages sweetened with high-fructose corn syrup increases the risk of gout.8,9 Purine-rich foods such as nuts, oatmeal, asparagus, legumes, and mushrooms do not seem to increase the risk.10 Consumption of dairy products appears to confer slight protection from gout10 .

      Diuretic use*

      Relative risk

      50 g per day vs. none

      2.53

      2 drinks per day vs. none

      2.51

      2 drinks per day vs. none

      1.60

      2 drinks per day vs. none

      1.05

      30 kg per m2 at 21 years of age

      2.14

      2 drinks per day vs. none

      1.85

      1,500 mg vs. < 250 mg per day

      0.55

      6 cups per day vs. none

      0.41

      *Adjusted for age.

      Adapted with permission from Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther. 2010 12:223, with additional information from reference 12.

      Diuretic use*

      *Adjusted for age.

      Adapted with permission from Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther. 2010 12:223, with additional information from reference 12.

      Hard nodules on distal digit.

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