What Are The Side Effects Of Prednisone?

Posted on Fri, 17 Feb 2017

Question: Primary diagnosis diffuse systemic sclerosis (2011) chronic restrictive dz - o2 dependent(had left lower lung wedge resection) dz polyarthraligias - was on Opana ER until 2016 - prescribed by PCP - laws changed (in United States) re meds - referred to pain mgmt. specialist for tx. MD said pain mgmt. spec does not treat pain associated with soft tissue dz. What options are avail. to me. Slow death from the dz, quality vs quanity of life, prednisone side effects, or clinical trial? Please be through with evidence based care plan and facts.(if possible)
i

Answered by Dr. Naval Mendiratta (48 minutes later)

Brief Answer:
Systemic sclerosis

Detailed Answer:
Good evening

Thank you for writing on health care magic

Before I guide you further on the options, there are a few things I would like to know about your disease...As the management does depend on the organs involved....

1. Do you experience raynauds often??Are there any ulcers along with it...

2. When you say polyarthalgia, is there any inflammation as well( swelling of the joints)

3. How many hours of oxygen are you on

4. When was your last 2D echo done , to assess the heart pressures...

5. Current medicines you are taking apart from recent Opana ER and Oxygen support...

Do let me know these queries. It is important to figure out how strong of a treatment you need, as the only organ which affects quality of life in Systemic Sclerosis is the lungs and I suppose it is affecting yours as well...We do have used a few new drugs( not FDA approved) but have shown excellent results...

Will do my best to guide you further

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Naval Mendiratta (3 hours later)

Raynauds often finger & toes turn blue w/temp change Swelling of hands, wrists, arm, knees, ankles (no s/s of pitting edema) - o2 therapy 2L during sleeping hours (deep sleep (REM) is rare or to keeps sats >93%. Pulm md reviewed CT chest result-per radiologist md no evidence of interstitial lung dz. pulm md thinks my symps. did indicate interstit. dz
Echo last performed 2011 unremarkable. Heart XXXXXXX (2011) cardiology findings - (L) ventricular angio - no evidence of mitral regurg Coronary angio - free of any angiographically sign. stenosis. (L) anterior descend free of any angiograph stenosis.
Medications - No longer on Opana ER (PCP that rx closed his private practice in XXXXXXX 2015. New PCP October 2015. Due to new rules/regs opiods the "md practice" made a decision to not prescribe opioids refer patient to pain mgmt. . Pain Mgmt Physicians will not treat soft tissue dz. 1/2016 After discussing w/practice mds they agreed to allow him to prescribe Oxycodone/Aceta 5mg/325mg (1 very 8hrs prn) for extreme pain - as per guidelines just because patient receives 90 tablets for thirty days - pt should exercise restraint 90 pills should last longer. Other meds - Replax PRN migraine h/a. Phenergan PNA n/v
Cymbalta 30mg/3 qd, Mobic 15mg PRN sciatica, amlodipine 5mg daily, Elavil 75mg q hs. while I do understand this cocktail of meds used in incorrectly can be fatal to the patient. The new meds you mentioned what stage (animal vs. real people) Thank you for time.

Answered by Dr. Naval Mendiratta (2 hours later)

Brief Answer:
Disease activity

Detailed Answer:
Good evening

Thanks for the reply

To summarize:

1. Raynauds
2. ILD( Not sure why the radiologist doesnt feel it is ILD...There would be no reason for you to be on oxygen therapy if there was no ILD)
3. Polyarthalgia

Couple of things I would like you to get done

1. 2 D echo--> Reassess the pulmonary pressures of the heart as they may be worsening your shortness of breath

2. Pulmonary function test

Few things I want to know:

1. Is there a reason you are not on prednisolone..Was it side effects or you opted out for it? AS that is the only drug which can slow down the ILD worsening...

2. You are not on much of immunosuppresion for your disease..All symptomatic treatment is going on..We need to control the inflammation process for your pains and life style to get better...IT may come with some side effects but at least your quality of life will improve

As for the new drug mentioned:

We have been using Rituximab in Scleroderma patients ( Scl 70 +ve)...RAther lot of rheumatologist use it and it is very benefical if used at an early stage. Apart from your ILD, it may be beneficial in your case. It still holds FDA approval but trials are going on and it has shown good results in our patients...

I am trying to fit in the loopholes in your management...Somewhere we are lacking in starting medicines which halt the disease process. DO let me know these queries

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (26 hours later)

Greetings - Re Prednisone side effects was a factor - after much thought and discussion w/PCP, Pulm re: myth vs. facts felt at the time (2012-2013) time to delay use of prednisone until symptoms worsened.
2014 pulm md signed off -pulm func test improved, o2 requirement decreased from 24hrs to 8-10hrs, activity level went from bedrest w/BR priv. to out of bed. 30-45min.MDs felt perhaps the dx process had plateau(ed)
Re: ILD diff in interp. pulm md said perhaps radiolog md didn't have all the pieces of my puzzle (symptoms, o2needs diag of systemic sclerosis, pulm func results) my thought was he didn't want to disparage radiologist as they both worked for same patient treatment center and I understand that-life in today's litigious world Request for CT listed reason for exam as S/P left lower lung wedge resection hence lack of radio md not knowing diag of systemic sclerosis
I am sign up for unlimited specialist subscription would you consider to be my contact/md? I haven't reviewed info to see if subscript allows - I want obey the rules of the serv - here is hoping you will agree to be my contact and and the rules allow. Thank you for your expertise, compassion & guidance.
Hoping you have bountiful blessings I hold you in highest esteem
Additional info - Secondary diagnosis - lung involvement in Scc ** systemic lupus.***No apology necessary I will gladly wait behind your patients their needs are urgent - I am not - I would feel guilty if it was in any other way. those in the healthcare profession who truly care about their patients often forget to take care of themselves you have many miles to go in your journey please don't push yourself to burnout or whatever the new buzz word is. I am glad you mention yoga - I am just beginning some would say newbie more like newborn infant stage
Prednisone you are the 1st in medical comm who took time to explain benefits i.e. reduce o2 require I had never been told that it might help with w/pain mgmt. Where I live there is not one single rheum that my PCP w/refer me to (lack of knowledge, lack of listing to their pts) I just learned the rheum I had in 2011 did not retire and will see me next week. I will proceed w/2D echo PFTs and let you know the results.
Thank you for kindness and willingness to continue to follow my case
words are not enough - I think some one famous said "...may the wind be always be at your back.... "May your blessings be many Deepest regards

Answered by Dr. Naval Mendiratta (2 days later)

Brief Answer:
Further course

Detailed Answer:
Good evening

Hope you are having a wonderful day

1. Well, we always try Holistic approach in our patients. Medicines can only get you so far, rest you need lifestyle modifications and exercises to keep yourself motivated all the time to fight the disease..Or else depression sets in..Yoga does give you positive energy along with exercises for the lungs which have proven to be helpful...

2. DO consult about prednisolone. Low dose will help improve your quality of life...

Do let me know these results and how the appointment with rheumatologist goes

Regards
Dr Naval

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee