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Dr. Gott 0102

Reader gives three cheers for extended use of prednisone

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Posted: January 2, 2007 12:33 p.m.
Updated: January 17, 2007 5:00 a.m.
    DEAR DR. GOTT: I am a long-time reader and believer in your column.
    I must, however, take issue with your advice to patients with polymyalgia rheumatica — specifically, your advice against the use of prednisone. I have been taking prednisone daily for the past 40 years (except for the time lapses required to convince a new doctor to prescribe it for me). Although I have multiple ailments (I am 77 years of age), I have yet to suffer from any of the signs and symptoms that you attributed to continued use of prednisone. I developed bronchial asthma at the age of 35. After trying numerous medications without significant relief, I received prednisone, and it has been a godsend to me.
    I believe that many ailing patients have needlessly been deprived of significant relief because of doctors’ reluctance to prescribe prednisone. I am aware that many patients do, in fact, sustain the cited side effects. I would urge you and the medical profession to take a new look at this matter to determine whether patients who take low dosages of prednisone cannot continue the same safely for long periods of time without undesirable side effects.
    DEAR READER: There are few issues in medicine today that better describe the value of the risk/benefit ratio in medication and other therapy. Prednisone and other steroid supplements have a dangerous and extensive list of potential side effects. These effects are generally related to length of steroid treatment and its dosage. On the other hand, prednisone is an effective treatment for many conditions, some of which — like PMR — can cause chronic pain and other serious consequences.
    The issue is clear: Is the risk of potential side effects caused by steroids outweighed by the benefits of therapy?
    Several autoimmune diseases and severe allergies can be brought under control with steroid treatment. This would indicate that the benefits exceed the risks. On the other hand, trivial acute problems — such as poison ivy — or chronic symptoms, such as joint pain, should not be treated with prolonged prednisone therapy. The risks of treatment outweigh the benefits. Patients should discuss this difficult topic with their doctors. Together, they can decide on a reasonable course of action.
    As I am sure you know, there are now inhaled steroids for use by asthma patients. The side-effect profile is excellent, and the sprays are a wonderful addition to the class of anti-asthma drugs. If I were you, I’d run this by your family practitioner. Should you be a candidate for the new product, it could help you — at a fraction of the risk of steroid pills.
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