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PostFri Jan 04, 2013 1:39 pm » by Fatdogmendoza


@ Spock

I am a phone counsellor for the National Rheumatoid Arthritis Society in the UK...

I have had dealings with Pred for many years...I had to wean myself off it...although once or twice a year when needed, usually when I go on holiday/ vacation I have a Pred injection to get me through..complete pain relief and joint flexibility is great for the two weeks..

Moon face/facies weight gain and sometimes mood swings/ aggression are also common side effects..




What are steroids?

Steroids are naturally occurring chemicals that help to make the body work, and are also used as medicines.There are many different types of steroid, for example there are those used by weightlifters and body builders (anabolic steroids), but usually when we talk about treatment for arthritis we mean the glucocorticoids. Sometimes doctors also use the word corticosteroids. The glucocorticoids produced by the body are called cortisone and hydrocortisone and they help to control metabolism (the chemical reactions in the body's cells that convert fuel from food into energy). During the day, when you are active, there are more glucocorticoids produced. During the night, when you sleep, there are less glucocorticoids produced. (If you have been a night shift worker for a long time, this will swap over.) If your body needs to work harder than usual, for example when you get an infection or other illness, it produces extra glucocorticoids to help.
Do steroids affect inflammation?

One of the effects of glucocorticoids, especially if extra glucocorticoids are made by the body or taken as tablets, is to change the way the body's immune system works. The body's immune system usually protects you from infection and helps to repair cuts, bruises and other injuries. In some diseases, however, the immune system attacks part of the body. Rheumatoid arthritis is one of these diseases, and the immune system attacks the joints, causing inflammation inside them. It is this inflammation that causes the pain, swelling and stiffness in joints affected by rheumatoid arthritis. When there is a lot of inflammation in the body, we would expect extra glucocorticoids to be made. These would help to cut down the inflammation. One of the mysteries of rheumatoid arthritis is that, in spite of inflammation often occurring in many joints, the body does not produce very much extra glucocorticoid.
What are steroid tablets?

If the naturally occurring glucocorticoids cortisone or hydrocortisone are taken as tablets, their effects wear off in just a few minutes. The glucocorticoid tablets prednisone and prednisolone last much longer (as do some injectable forms of glucocorticoid, such as depomedrone and triamcinolone). In the average person, all the cortisone and hydrocortisone produced in 24 hours would add up to the same amount of glucocorticoid as about 5 or 6mg of prednisone or prednisolone.
How do steroid tablets help rheumatoid arthritis?

The first and most obvious effect is to reduce inflammation. A low dose (for example 7.5 mg prednisone or prednisolone daily) will usually have a clear noticeable effect within a few days of starting treatment. Joint pain, stiffness and swelling will be less, particularly in the mornings when the body needs higher levels of glucocorticoid. A larger dose (for example 25 mg daily) will usually have a larger and quicker effect. Very large doses, given as one-off injections (called pulses), can often provide a quick improvement that can sometimes seem almost miraculous.

A second effect, more obvious to some patients than to others, is that glucocorticoids make you feel better in yourself. They provide a 'sense of well-being'. We do not know why this happens but in some people given large doses of glucocorticoid this can result in them becoming enthusiastically over-active.

A third effect is not obvious at all to patients. This is because glucocorticoids seem to work on another process in rheumatoid arthritis, different from inflammation. In most patients, the arthritis gradually damages the joints slowly, over the years (known as joint erosions). This damage can show up on x-rays of the joints (usually the hands and feet) but takes a long time to be visible from the outside. There is now very strong evidence that glucocorticoids (prednisone and prednisolone) are able to reduce this joint destruction.
If steroids are so good, why doesn't everyone take them?

The problem is first, the benefits of glucocorticoid medication on symptoms often do not last and second that glucocorticoids can cause side effects.

The biggest improvements in symptoms, from injections, last the shortest time (days or weeks). Large regular doses of tablets can provide relief of pain and stiffness for many months, but the arthritis usually eventually breaks through. Low doses maintain a smaller but useful effect on inflammation for up to a year or so (and may continue to provide a 'sense of well being' for longer). In the end, however, if the rheumatoid arthritis remains active the symptoms of inflammation will gradually show themselves.

The other effect of glucocorticoids (protecting the joints from damage) has continued for as long as they have been tested. Indeed, the evidence now shows that patients treated early in their condition will continue to benefit from reduced joint damage many years later, even after the glucocorticoids have been stopped. However, this has not yet been properly tested in patients whohavewho have had their arthritis for many years. As the evidence is now so strong, it is becoming more common to the National Institute of Health and Clinical Excellence (NICE) recommends the use low doseof glucocorticoids to prevent joint destructionin newly diagnosed patients.
What side effects do they have?

It is the side effects of glucocorticoids that have given them a bad name in some peoples' eyes. There is no doubt that high doses of glucocorticoids over many months or years can (and usually do) cause serious side effects. We know this from the early enthusiasm of doctors to treat patients with high doses to control their symptoms when glucocorticoids were first discovered over 50 years ago. (In those days, the possible side effects were not known about until much later.) We also see these effects in patients with serious and life-threatening diseases (such as severe asthma, or even some rare but serious complications of rheumatoid arthritis) who need high doses of glucocorticoids just to stay alive. However, in lower doses the side effects take a long time to appear and are much less serious. Nevertheless, there needs to be a good reason for taking even low doses of glucocorticoids to balance against the side effects which might develop.

The biggest side effects of glucocorticoids usually only occur after high doses for long periods of time. They include diabetes, heart disease, high blood pressure and obesity.

Other side effects can occur even on moderate or low doses. They include fragility of the skin (leading to bruising), thinning of the bones (called osteoporosis) and a tendency to put on weight. Patients who already have diabetes might find it harder to control. Also, once your body has got used to taking glucocorticoid tablets, it complains if the dose is reduced too quickly because it re-sets its internal glucocorticoid controls. Stopping suddenly can in theory be dangerous, and even stopping slowly can make you feel as if your arthritis is getting worse.

There are some side effects that might build up slowly over many years in some patients, even on a low dose of glucocorticoid. These are not easy to measure but probably mean that patients are slightly more likely to get heart problems and osteoporosis; although the latest evidence is that when treating rheumatoid arthritis these risks are very small and are certainly very small, compared for example, to the risk of getting lung cancer from smoking cigarettes.
Can the risks of steroids be reduced?

The risks depend on the total amount of glucocorticoid taken over the years (and the condition for which it is prescribed) so the best way to reduce the risks is to only take the lowest dose of glucocorticoid that is needed to do the job. There is now good evidence that the risk of osteoporosis can be reduced by taking bone protective treatment with the glucocorticoid. This anti-osteoporosis treatment will usually be prescribed if you are going to take more than 7.5 mg prednisolone for more than 6 months. Some doctors recommend anti-osteoporosis treatment for any long-term dose of glucocorticoids.
How do I know if I should be taking steroids?

The best treatment for an individual patient is best discussed between the patient and their doctor. A few people develop serious complications to their rheumatoid arthritis, which means that, in spite of the risks, it is still best for them to take even quite high doses of glucocorticoid. Patients who need rapid short-term control of symptoms might be given glucocorticoids by injection or as tablets for a few weeks or months. Patients who develop new rheumatoid arthritis are often offered prednisolone 7.5 mg daily either at a low dose of 7.5 mg daily, or sometimes at a high dose (60mg daily) quickly reducing to the low dose over a few weeks, and then continue low dose treatment for 2-4 years to control the joint destruction. These patients can also get symptom improvement for a year or two as a kind of 'beneficial side effect'.

We should all try to avoid the trap of varying the dose of glucocorticoid to match the changes in the way arthritis inflammation causes symptoms. This usually leads to gradually increasing doses (as the effects of lower doses wear off) and then the risk of side effects becomes serious. As patients, you are best placed to keep an eye on this and to look after your own long-term future.

PM me if I can be of any help spock.. :flop:
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PostFri Jan 04, 2013 2:04 pm » by Spock


Thanks FatDog, that is a wealth of information and my wife is excited to read it too, so I'm emailing it to her.

This was my suspicion and paranoia the whole time, and really all I need to base my decision on why not to take it...

The biggest side effects of glucocorticoids usually only occur after high doses for long periods of time. They include diabetes, heart disease, high blood pressure and obesity.

Other side effects can occur even on moderate or low doses. They include fragility of the skin (leading to bruising), thinning of the bones (called osteoporosis) and a tendency to put on weight.

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PostFri Jan 04, 2013 2:11 pm » by Spock


BTW FatDog...

I was taking (3) 10mg pills each day, morning, midday and evening.

Was supposed to reduce to (2) then (1) over the course of a month, but I just dropped it cold turkey after stepping on the scales and seeing that 5 pounds.

Funny, back when I stayed drunk, except for being fat and depressed, I didn't have any ailments, or maybe I just don't remember having them.

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PostFri Jan 04, 2013 2:53 pm » by monica44


[quote="Spock"]BUMP...

I had to watch this again for motivation to get back on the juice after this holiday season of gluttony.

I gained 5 pounds over the holidays (as I'm sure most of it is water retention)



Slightly off topic from juice extractors etc, but i thought i would share a handy tip for those who want to lose up to 8lb in one night, that is to put Epsom salts in the bath and relax, the salts will draw out some of the excess water in one go, boxers do it if they got to drop a few pounds before a fight. Just make sure you have a glass of water after the bath as the salts can dehydrate you. :cheers:
We are not human beings on a spiritual journey, we are spiritual beings on a human journey; Stephen Covey.

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PostFri Jan 04, 2013 4:10 pm » by Fatdogmendoza


monica44 wrote:
Spock wrote:BUMP...

I had to watch this again for motivation to get back on the juice after this holiday season of gluttony.

I gained 5 pounds over the holidays (as I'm sure most of it is water retention)



Slightly off topic from juice extractors etc, but i thought i would share a handy tip for those who want to lose up to 8lb in one night, that is to put Epsom salts in the bath and relax, the salts will draw out some of the excess water in one go, boxers do it if they got to drop a few pounds before a fight. Just make sure you have a glass of water after the bath as the salts can dehydrate you. :cheers:


lol

Image

:mrgreen:
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PostFri Jan 04, 2013 4:19 pm » by Fatdogmendoza


Spock wrote:BTW FatDog...

I was taking (3) 10mg pills each day, morning, midday and evening.

Was supposed to reduce to (2) then (1) over the course of a month, but I just dropped it cold turkey after stepping on the scales and seeing that 5 pounds.

Funny, back when I stayed drunk, except for being fat and depressed, I didn't have any ailments, or maybe I just don't remember having them.


Yeah coming off doesnt suit everybody...Some people really do/ may need the pred...You did well to make your mind up and stop...The problem is one ailment leads to another...Take a tablet to line the stomach because another tablet causes severe indigestion but hey long term use of that tab can lead to atrophy of the stomach lining that...Thats the inescapable catch...anyways I in it for quality of life with my kids not years and years of suffering with no physical interaction... I do what I have to do, but not ignorantly....I have become an expert on my illnesses and all of the different types of treatments in order that I am able to make a highly educated decision on what steps suit me...I also took part in the Expert Patients Programme at my local specialist health centre...Thats just me tho...

Keep as well as you can spock, but in the end its only you who can make the big decisions...Good luck...its a bloody quagmire :hugging:
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PostFri Jan 04, 2013 4:27 pm » by monica44


Fatdogmendoza wrote:
monica44 wrote:
Spock wrote:BUMP...

I had to watch this again for motivation to get back on the juice after this holiday season of gluttony.

I gained 5 pounds over the holidays (as I'm sure most of it is water retention)



Slightly off topic from juice extractors etc, but i thought i would share a handy tip for those who want to lose up to 8lb in one night, that is to put Epsom salts in the bath and relax, the salts will draw out some of the excess water in one go, boxers do it if they got to drop a few pounds before a fight. Just make sure you have a glass of water after the bath as the salts can dehydrate you. :cheers:


lol

Image

:mrgreen:





LOL :lol: Yeah something like that :cheers:
We are not human beings on a spiritual journey, we are spiritual beings on a human journey; Stephen Covey.

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PostFri Jan 04, 2013 4:32 pm » by Spock


monica44 wrote:Slightly off topic from juice extractors etc, but i thought i would share a handy tip for those who want to lose up to 8lb in one night, that is to put Epsom salts in the bath and relax, the salts will draw out some of the excess water in one go, boxers do it if they got to drop a few pounds before a fight. Just make sure you have a glass of water after the bath as the salts can dehydrate you. :cheers:



You must be taking massive Epsom salt enemas too. :mrgreen:

I take bath is Epsom salt regular, at least 3 times a week, and have never lost weight from it. If i did, I would work from my tub.

I may be a manly man, but I love me my Calgon moments.

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PostFri Jan 04, 2013 4:39 pm » by Slith


Fatdogmendoza wrote:
Image



Jeebus, that almost looks erotic!
















:peep:
Image

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PostFri Jan 04, 2013 4:45 pm » by monica44


Spock wrote:
monica44 wrote:Slightly off topic from juice extractors etc, but i thought i would share a handy tip for those who want to lose up to 8lb in one night, that is to put Epsom salts in the bath and relax, the salts will draw out some of the excess water in one go, boxers do it if they got to drop a few pounds before a fight. Just make sure you have a glass of water after the bath as the salts can dehydrate you. :cheers:



You must be taking massive Epsom salt enemas too. :mrgreen:

I take bath is Epsom salt regular, at least 3 times a week, and have never lost weight from it. If i did, I would work from my tub.

I may be a manly man, but I love me my Calgon moments.



What a scream you are hilarious, not sure about the enemas lol, but it is a well known idea, i will try and find a link, although i do know you have to put loads in. :cheers:
We are not human beings on a spiritual journey, we are spiritual beings on a human journey; Stephen Covey.


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