Prednisone rheumatoid arthritis

The introduction of double bonds changes the stereochemistry of a molecule and decreases the flexibility of carbon chains. The E and Z isomers may show very different binding properties for example, the A -double bond of prednisone (3.7) increases its activity against rheumatoid arthritis over that of its parent compound cortisol (3.8)... 

Azathioprine and mercaptopurine appear to be of definite benefit in maintaining renal allografts and may be of value in transplantation of other tissues. These antimetabolites have been used with some success in the management of acute glomerulonephritis and in the renal component of systemic lupus erythematosus. They have also proved useful in some cases of rheumatoid arthritis, Crohn s disease, and multiple sclerosis. The drugs have been of occasional use in prednisone-resistant antibody-mediated idiopathic thrombocytopenic purpura and autoimmune hemolytic anemias. 

Two women and one man, aged 53-74 years, died after they received thrombolytic therapy for acute myocardial infarction. All three had a long history of seropositive rheumatoid arthritis treated with prednisone 5-20 mg/day for many years. 

A 57-year-old man took prednisone 20-30 mg/day for 13 years for rheumatoid arthritis (52). He had been... 

A 47-year-old woman developed a gastrocolic fistula during treatment with aspirin (dosage and duration of therapy not stated) and prednisone for chronic rheumatoid arthritis (148). 

A 74-year-old woman with seronegative rheumatoid arthritis was given sulfasalazine followed by methotrexate, both of which were withdrawn because of adverse effects. She also took prednisone 10 mg/day. She developed acute abdominal pain and fever (38.7° C) with no chills. Her serum amylase was 269 IU/1, serum lipase... 

The effects of risedronate on bone density and vertebral fracture have been studied in 518 patients (mean age 59 years, 40% with rheumatoid arthritis, 56% men, 64% of the women postmenopausal) taking moderate to high doses of oral glucocorticoids (equivalent to prednisone... 

Conn DL, Lim SS. New role for an old friend prednisone is a disease-modifying agent in early rheumatoid arthritis. Curr Opin Rheumatol. 2003 15 193-196. 

Prednisone is used in the treatment of autoimmune diseases, both organic-specific autoimmune diseases such as myasthenia gravis and idiopathic thrombocytopenic purpura and nonorgan-specific autoimmune diseases such as lupus erythematosus, rheumatoid arthritis, and periarteritis nodosa. In addition, prednisone is used in patients receiving organ transplants and is of paramount value in countering the problems associated with organ rejection. 

Corticosteroids have been used in 60-70% of rheumatoid arthritis patients. Their effects are prompt and dramatic, and they are capable of slowing the appearance of new bone erosions. Corticosteroids may be administered for certain serious extra-articular manifestations such as pericarditis or eye involvement or during periods of exacerbation. When prednisone is required for long-term therapy, the dosage should not exceed 7.5 mg daily, and gradual reduction of the dose should be encouraged. Alternate-day corticosteroid therapy is usually unsuccessful in rheumatoid arthritis. 

Posterior subcapsular cataracts (PSCs) can occur with all routes of administration (Figure 12-2), including systemic, topical, cutaneous, nasal aerosols, and inhalation corticosteroids. In a study of 44 rheumatoid arthritis patients treated with various steroids, including prednisone and dexamethasone, 17 (39%) developed bilateral PSCs. Dosage and duration of therapy appeared to be correlated with the incidence of cataract development. Patients who received prednisone therapy for 1 to 4 years showed an 11% incidence if the dose range was less than 10 mg/day a 30% incidence if the dose was... 

Figure 12-2 Posterior subcapsular cataract (arrows ) in a 48-year-old man who had taken oral prednisone, 7.5 mg/day, for 13 years for the treatment of rheumatoid arthritis. Visual acuity was 20/30 (6/9)-...

A gastrocolic fistula developed in a 47-year-old woman taking aspirin and prednisone for rheumatoid arthritis (57). Other similar case reports have been published (58,59). 

A 57-year-old man took prednisone 20-30 mg/day for 13 years for rheumatoid arthritis (45). He had been treated unsuccessfully with gold, azathioprine, hydroxychloroquine, and sulfasalazine tapering his glucocorticoid dosage had been unsuccessful. He developed worsening back pain in his thoracic spine and lateral... 

A-60-year-old woman with rheumatoid arthritis who was taking prednisone, azathioprine, suhndac,... 

A 67-year-old woman with a 5-year history of rheumatoid arthritis, who had taken prednisone and methotrexate, was given infliximab (55). Her rheumatoid arthritis improved, but she developed multiple bilateral lesions of molluscum contagiosum on the upper and lower eyelids, despite normal CD4 and CDS counts. She had had similar lesions during a previous course of infliximab. Excision biopsy confirmed the diagnosis. 

A 55-year-old man with chronic lymphocytic leukemia and rheumatoid arthritis took methotrexate for 4 years and developed a B cell non-Hodgkin s lymphoma in the shoulder and axillary lymph nodes he had Epstein-Barr viral antigens in the serum. After radiation and chemotherapy had failed, complete remission was achieved with a combination of rituximab and EPOCH (etoposide -I- prednisone -I- vincristine -I-cyclophosphamide + doxorubicin). 

Wolfe F. Inflammatory activity, but not methotrexate or prednisone use predicts non-Hodgkin s lymphoma in rheumatoid arthritis a 25-year study of 1767 RA patients. Arthritis Rheum 1998 41(Suppl) S188. 

Pincus T, Marcum SB, Callahan LF. Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices II. Second line drugs and prednisone. J Rheumatol 1992 19(12) 1885-94. 

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