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Ask Dr. Gott 4/10
Wean slowly off prednisone
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    DEAR DR. GOTT: I have been taking prednisone, 10 milligrams daily, for 14 months for polymyalgia rheumatica. I cannot take less than 8 milligrams without having a lot of pain in my wrists and hands. I have researched this and discussed my concerns with my rheumatologist, who has put me on methotrexate (four tablets of 2.5 milligrams once a week) to try to wean me off the prednisone. Is this the lesser of two evils? I worry about the long-term side effects of both medicines and, more importantly, how to cure the PMR. Any suggestions?
    DEAR READER: PMR is an autoimmune disorder that causes muscle pain and stiffness in joint areas. Over-the-counter medications or, in severe cases, oral steroids can reduce inflammation and relieve pain. PMR can be a disabling disorder requiring aggressive therapy to reduce the body's immune response. Unfortunately, the treatment is not without risk.
    You apparently have progressed from over-the-counters to prescription medications, and I cannot advise you which drug to take. That decision depends on your response to each medication. Methotrexate is less troublesome than prednisone, but it still has its own side effects.
    Although some patients improve after many years, PMR is usually permanent and incurable. Therapy to treat symptoms is extremely effective but must be taken for years.
    You are in good hands. Your rheumatologist has made sound decisions so far. I urge you to stick with his or her recommendations. Review your health issues with your doctor periodically and try to get by on the smallest amount of medication that controls your pain.

    DEAR DR. GOTT: I'm a 73-year-old male. I get flyers in my newspaper every couple of months for Life Line Screening and have forwarded one to you for your comments. Are the tests offered worth the money, and do they do a good job?
    DEAR READER: These flyers are extremely useful in directing you to testing offered in your area. The services are offered at a fraction of the cost charged by your local hospital or health care center. The flyer you sent me publicizes screening for carotid artery stenosis (a common cause of stroke), abdominal aortic aneurysm (a potentially fatal thinning and ballooning of the major artery feeding the lower body), osteoporosis and peripheral vascular disease (arterial blockages in the legs).
    I encourage you to take part in the program unless you have had recent, similar testing performed. All procedures offered are noninvasive, painless screenings using Doppler ultrasound technology.
    A board-certified physician who is fully insured and licensed to practice medicine will review and confirm all results. Should you have any abnormal readings, I recommend you take the reports to your primary-care physician for interpretation and possible follow-up.
    To give you related info on two of the conditions mentioned, I am sending you copies of my Health Reports "Stroke" and "Osteoporosis."
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