How does prednisone work?

I'm wondering does prednisone NEED to be started at a high dose and then tapered? Or would a smaller doseage (20mg) over a long period of time eventually take care of inflammation?

I've been on 20mg for a week, with no relief in symptoms. My doctor is having me stay on the 20 for an extra week and then taper much slower than originally planned. Will the prednisone provide relief eventually, or do I need a bigger dose to begin with to sort of *shock* it?

This is how Pred works:

- Start on 40mg
- All your symptoms disappear and you feel great. So much energy etc.
- Reduce to 35mg
- The extra energy goes away; disappointing, but you still feel much better overall
- Reduce by 5mg/week
- Symptoms return long before you reach 0mg
- Limp along with symptoms for another year or so until you have another acute flare-up
- Start on 40mg, etc. etc.
- Rinse and repeat for a few more years until you are utterly steroid-dependent
- Have surgery

Moral of the story: find another med. Pred gets you nowhere in the long run.

Serious note, though, if 20mg Pred does nothing then even lower doses will do even more nothing. There's absolutely no mileage in doing an ultra-slow taper if you have no relief at the dose you are currently at.

You can try going up to 40mg and seeing if that works. Or you can read my last post and look for a long-term maintenance med which doesn't stop working within 2 seconds of you dropping below a certain dose.

Edit: Argh, Jen, you ruined my flow! :p

Steroids kept me out of the hospital all right; and I was straight back in there once I was off the steroids :-/ In my case, though, nothing else worked, not even the biologics. That's fairly unusual but certainly far from unheard of.

That timeline was spot on. It took me months of up and down to finally get off of the steroids from my bad flair. But I did end up getting off of them and into remission with no additional maintenance med. (Mainly because we were still in process of diagnosing.)

My current doctor believes that I have extremely minimal inflammation going on which is causing my arthritis to flare. We tried sulfasalazine and I had a pretty bad/strange allergic reaction to it, although it was really helping, both my joints and my stomach.

The next med he is putting me in is Imuran, but we both agreed to try a small stint of pred before going to the imuran. I'm doing well, aside from random stomach symptoms and the joint pain, so I am not terribly comfortable starting the Imuran.

I was hoping the prednisone would knock out whatever minimal inflammation is going on, but 20mg doesn't seem to be doing anything but make my heart race. I have osteopenia so I dont think he will go above 20mg, but I also don't want to be tapering off of this for two months if there will be no benefit. I was supposed to be on 20 for one week, and tapered off in two weeks, initially.

I'm thinking about increasing my doseage on my own. How bad of a decision is that?

He gave me a few refills so I shouldn't run out, but I know that I should ask him before making any changes 😔