If you've noticed, I haven't been quite as active here in the past few weeks as I have been. Well, I'm coming down off one heck of bad "trip" on Prednisone. Several years ago, I was diagnosed with rheumatoid arthritis. Nasty stuff indeed, but for me, it sort of settled in my right knee and left everything else along. It's been pretty much in remission for the past couple of years, but about a month ago, it started flaring back up.

Went to the docs, tests showed the RA was indeed flaring (there's some relatively new test, "CCP" or "CPP" or something that is better than the old RF factor test) and they decided to hit it aggressively and try to keep my knee from swelling up so much again and doing any more damage.

Part of that was a course of prednisone. They wanted me to take 20mg per day, as two 10mg tablets, one in the morning and one in the evening. And note this it not that high of a dose, all in all. I was to do that for 10 days and see what happened.

Well, I started it. After about 2 days, I was feeling great, top of the world (that's a false steroid "euphoria", actually. You ain't as great as you feel you are, which means you can overexert yourself and do damage).

By day 5, my little spring was wound up so tight, it was about to fly apart. I'm talking wired. I've never had cocaine or amphetamines, but this was just what I imagine a high dose of that would feel that. There was a constant "adrenaline rush" feeling, hot, prickly flashes running up and down and all over my body. Sleep? Hah. I laid in the bed to about 4AM, eyes wide open, and then just got up.

By that time, I noticed my hands were shaking. I knew it was the Prednisone. I took my BP and pulse. My BP normally runs about 110 - 115 systolic when I'm sitting, and my pulse rate is in the high 70s. But here it was up to 140/90 and my pulse was over 100.

And then I started getting a little squirrely with anxiety -- little worries running amok in my mind. I debated about going to the ER right then and there, but I decided to wait and just go to my doc when he opened in the morning. I got there, he saw the BP and other signs, and wrote me out a script for Ativan right there, and told me to just stop the Prednisone dead right there.

It took 2mg of Ativan just to take the edge off at the start. I took 4mg total that day. It took me several days just to come off that "high", and boy what a crash it was. After that, they wanted me try just 5mg of Prednisone, but in a few days of that, I was getting wired again and it took
1mg Ativan per day there. It wasn't as bad as the first 20mg episode, but it was winding me up noticeably, and he said just forget about the Prednisone for a while.

And so right now, I'm just coming off that mess. Apparently, I'm very sensitive to Prednisone. We're looking at all sorts of things that can do that. May just be me. However, hypothyroid conditions and some other things can exagerate steroid effects, and some of the symptoms of those things are ringing some slight bells. While it's not unheard off at low doses, this kind of reaction usually occurs at much higher doses.

There is a thing known as "steroid induced psychosis", which includes prednisone as well as the anabolic types the bodybuilders use. You can look it up if interested, but what happens is the steroids can get the limbic system of the brain overexcited by various mechanisms. Honestly, I believe I was headed down that road had I not stopped it. A few more 20mg hits, and I'd probably have been in a padded cell, seeing and hearing things. And I'm not joking too much at all.

-Richard

Yikes!
Have you tried DMSO?
(It's ~US$7.00/pint, applied topically after diluting 50% with distilled water and usually available at feed & tack stores.)

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I can relate, Publius. I sometimes wonder if the idea for "cordrazine" in Star Trek came from prednisone. For most people, it's a very useful and powerful anti-inflammatory drug if taken for short periods, but people react differently, and the effects become more pronounced with longer use. I could handle 20 mg without too many nasty effects for a couple of weeks, but I was on varying doses over an extended time. At the highest, I was on 60 mg for more than a month. At that dosage, I knew I wasn't thinking straight, but I couldn't do much about it - I didn't have too many alternatives. It wasn't a good feeling at all. And, I didn't need blood pressure medicine until I took prednisone (it never fully came back to pre-pred levels even after I got my weight back to normal).

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Prednisone never altered my moods, not that I noticed anyway, but it made me retain a lot of water and I was never comfortable while on it. I looked and felt utterly bloated. Worse, it tended to pull liquid into my joints, which meant my fingers would tend to seize up overnight. And I mean that it took five full minutes to work my fingers enough that I could close my hand. Another half-hour to make a fist.

The first time, that "side effect" lasted three months after I stopped the prescription. The second time, it never went away completely. The third time I "needed" it, I demurred. The alternative was surgery to rebuild me (they had the technology), and that's what I got.

Never again.

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"your going to regret that one. You are now a colonoscope...
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Publius,
Sorry to hear about that.
You are (of course) right about the psychological effect of steroids, that can trigger both elation and depression, as well as psychosis. It's not usual, most people get enormous benefit, certain people get the side effects and it may be genetically determined. Tough, if you suffer from RhA.
Have you tried the non-steroidal anti-inflammatories? They got a bad name (Vioxx) recently, but every drug has its side effects and you may get the good without the bad of another type of drug.

John

I have a rare disease retro-peritoneal fibrosis (RPF). Doctors are now claiming it is probably an auto-immune disease much like RA. They really don't know what causes it or how to cure it. Many doctors prescribe steroids to counter the flair ups. Luckily, my doctor, like me, thinks that stuff is poison. He suggested surgery to fix me and I jumped on it. When I suffer a flair-up I just suffer through it. Unless it starts affecting more major organs or my aorta I'll just continue to wait out the flairs.

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Oh, yes. I took Celebrex for several years, and I thought that did fairly well. However, it is quite expensive. Several months ago, my doc told me to try Mobic (generic meloxicam), which is much, much cheaper, and I think that is doing fine. It's hard to say, but if pressed, I'd say the Celebrex did a little better but all that's just too subjective really.

Meloxicam is more of a COX-2 "preferential" one. Celebrex and its class were supposed to be COX-2 specific. Mobic is supposed to target COX-2 more in low doses, but it still will affect COX-1, but not as much as the other well-known NSAIDs.

Like I mentioned above, they decided to aggressively go after it. It used to be they would just start out conservatively treating it, just trying to keep pain in check and maintain mobility, and wouldn't use the powerful drugs unless and until in got severe. However, that thinking changed over the past few years, as they discovered that joint damage would go along unabated, even if pain and other symptoms weren't so bad.

So the thinking switched to going after it aggressively early on.

And so they put me on methotrexate, which has become the first line "DMARD" for RA. Reading about that scared the poop out of me, but I'm apparently tolerating it well, and I think it's slowly improving. For example, when RA is flaring, there is strong morning stiffness, which had indeed returned in my knee. Takes over an hour sometimes to get that knee to move much. And the fatigue feeling was coming back as well.

Well, this morning, I noticed the morning stiffness seemed to be less. Knock on wood. Anyway, the idea is to stop the joint damage before it gets started with this flare.

The trouble with methotrexate is it can quickly and without much warning mess up your liver, and so they have to do liver tests monthly. There's a couple other nasty things that can happen, too.

Folic acid helps reduce some of the other side effects, and they have me taking >1mg per day. The only bad thing so far is I feel utterly wiped out the day after taking it. Oh, you take a pulse once a week -- they've got me at 15mg per week. The day after that, I'll be wiped out.

-Richard

Publius,
"I took Celebrex for several years, and I thought that did fairly well. However, it is quite expensive."
Ouch! But there are some advantages to the NHS, especially for chronic diseases.
John

sorry to here about your problems Publius.

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Thanks. But oh, no big deal in the grand scheme. I'm feeling sort of wasted and wiped out after that little roller coaster ride, but otherwise pretty much back to normal.

I am wondering about hypothyroid, though. From reading (more than I can keep straight, actually. ), it turns out that hypothyroidism is more prevalent in those with autoimmune diseases than the general population. Two to three times as prevalent depending on which study you look at. And hypothyroid condition can indeed amplify steroid effects.

The symptoms of hypothyroidism are vague and many, but quite a few are ringing some bells with me, and I'm going to bet I'm a little low. One indicator is basal body temperature, that taken right when you wake up in the morning, when body temperature is generally at its lowest.

Based on this suspicion I've taken it over the past couple days and it is indeed somewhat low, running about 96.8F. Interestingly, both armpit and oral were the same 96.8F this morning. Around midday, when body temperature is generally at the highest, mine has never exceeded 98.3F.

And then some of the other symptoms are increased intolerance to cold. Lately, I've noticed the cold just seems to really bite me, and my hands and feet will get cold easily. I've had to put a heating pad under my feet in bed under layers of blankets to keep them warm a few times this winter. And I'm keeping the house temperature around 70F.

Another big one is brittle fingernails, and poor cuticles.

So I'm suspecting hypothyroid and it makes sense to me that something else may be going on, here.

-Richard

Publius

There is a simple & reliable blood test for hypothyroidism. And many cases ARE due to autoimmune disease. get your doc to order the test, Even if you have to pay for it, it shouldn't be expensive. But you never know, in the US everyone gets gouged for anything to do with one's health.

They gouge you even more when you do not have insurance.

Get a test if you're concerned, but getting off of prednisone can have effects. I'm pretty familiar with changing temperature sensitivity.

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I say there is an invisible elf in my backyard. How do you prove that I am wrong?

Disclaimer: Avatar is not an official NASA image and does not imply any specific interplanetary or interstellar capability.

The Leif Ericson Cruiser

True. Stopping Prednisone cold turkey, after even only 20 mgm daily for only what seems to have been about a week, is pretty heroic treatment.

Actually, the thyroid test is already in the pipeline. They drew some blood last time, and are going to draw some more next week, and I forget which tests are for which batch. But I'll know in a week or so either way.

I've had these hypothyroid suggestive symptoms for some time, well before this prednisone round. I just didn't pay it much attention until now when I learned that a hypothyroid state can exagerate Prednisone response. Then I started reading all the various symptoms and signs of hypothyroid and it started ringing some bells.

Yes, there is an autoimmune disease that attacks the thyroid, causing low output, and maybe something else that makes antibodies against some of the thyroid hormones. Hashimoto's thyroiditis, I believe it's called.

But that is an autoimmune disease that attacks the thryoid itself. What I was noting here is that hypothyroid for whatever reason is more prevelant with autoimmune diseases of all types, RA, lupus, etc, etc. IOW, if you have an autoimmune condition, you're more likely to have hypothyroidism.

Incidently, it turns out the Lupus population has a very high incidence of bad psychological reactions to prednisone. They think that has something to do with abnormal serum albumin levels or some such.


-Richard

I stopped it cold for about 3 days, per the doc's order, until I wound down with the help of the Ativan. That was around the weekend of Feb 1st. Then they wanted to start up with just 5mg, which I took all last week. By the weekend, I was getting wired again -- not as bad, but I was having to pop the ativan to sleep. So, this monday, they said cut that in the half, and go for a few days and then quit. And that's where I am today.

So, it was only partial cold turkey. It was quite a crash, but that was more due to my wired state than withdrawal, I'm pretty sure.

As I understand it, while it might be unpleaseant, it's not dangerous to go cold turkey if you haven't been on it for more than a week or so. To be life threatening, you have to have been on it long enough to have really supressed your adrenal gland production.


-Richard

Oh, and don't worry too much about me an "heroic measures". I'm a tough old bird, one ornery cuss, to quote quite a few doctors (and dentists) who've had the dubious pleasure of treating me. I don't think they worry too much about putting me through a ringer because of it.

For example, when my knee flared up again and they took an X-ray, the doc walked in with the x-ray, put it up on the screen, then shook his head as he looked back and forth between the x-ray and my knee as I sat on the table. "Damn, boy, how can you stand to walk on that thing!", said he.

And when I went in all wound and wired up on the 20mg, he remarked after looking at my "vitals" showing how wound up in fight or flight I was, he couldn't believe how cool and collected I was maintaining myself outwardly. It wasn't easy, though, I'll grant him that, but that's how I am. Stiff upper lip. His giggly nurses (whom I love to make giggle as much as I can, much to his consternation) got all serious acting, asking me if I was out of breath, did my chest hurt, etc, etc. So that's how I get reputation as a cool cucumber.

-Richard

The only problem I ever had getting off meds was an antidepressant, I steeped myself down without doctors orders but I left the province the the subscribtion was issued in and did want to go to another doctor about. The only reaction sometimes a get little crankier then usual but does not happen as often as before, but it bets the urge to kill yourself anyday.

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My sympathies, Publius. I've been on the "evil" pred in various forms in the past, and it can be such a pain. My husband has had to put up with my mood swings from it, and I am so grateful to him for it!