Psoriatic arthritis (PsA) is a form of inflammatory arthritis that occurs when the immune system mistakenly attacks healthy tissue in the joints. These attacks trigger inflammation, which leads to joint pain, swelling, and stiffness.

Prednisone is a type of corticosteroid medication that helps reduce systemic inflammation. Doctors may prescribe prednisone in combination with other treatments to help alleviate PsA symptoms and control the progression of the disease.

This article describes what prednisone is and how it may help with PsA. It also provides information on how doctors prescribe prednisone and the possible side effects of this medication.

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Prednisone belongs to a class of medications called corticosteroids. These anti-inflammatory medications are synthetic versions of hormones that the adrenal glands produce.

Doctors may prescribe corticosteroids to help suppress the immune system or alleviate swelling and inflammation. Some conditions that corticosteroids may help treat include:

Prednisone is available under the following brand names:

  • Rayos
  • Sterapred
  • Deltasone

Each of these medications is available as an immediate-release tablet, a delayed-release tablet, or a liquid solution.

PsA is an autoimmune condition in which the body’s immune system mistakenly attacks healthy tissue, causing inflammation. In PsA, this inflammation triggers joint pain, swelling, and stiffness, and it may also cause a skin rash. Over time, this systemic inflammation can lead to permanent joint and tissue damage.

A doctor may prescribe prednisone to help suppress the overactivity of the immune system and reduce the production of chemicals that trigger inflammation. In these ways, the drug helps alleviate joint pain, swelling, and stiffness.

An older case study from 2013 suggested that early PsA treatment combining corticosteroids and disease-modifying antirheumatic drugs (DMARDs) could improve outcomes for people with PsA. Specifically, it may have the following benefits:

  • controlling joint inflammation in its early stages
  • preventing joint damage
  • maintaining long-term functional capacity and quality of life

People who take prednisone usually take it orally, as a tablet. Doctors recommend taking prednisone in the morning because it closely resembles the natural hormone cortisol, which is at its peak early in the day.

The severity of a person’s symptoms and their individual treatment goals will determine the amount of prednisone that they need to take. The optimal dosage will also depend on whether the person has any other underlying conditions.

According to the Arthritis Foundation, people who have liver scarring, called cirrhosis, or an underactive thyroid, known as hypothyroidism, may require a lower dosage.

Generally, the initial starting dosage of oral prednisone is 5–60 milligrams (mg) a day. A doctor may adjust or maintain the daily dose until they are satisfied that PsA is well-controlled. They will then gradually reduce the daily dose in small increments to establish the lowest dosage necessary to manage the condition effectively.

The authors of a 2013 case study reported that a combination of DMARDs and alternate-day low dose prednisone significantly improved one individual’s severe PsA symptoms within a week. Tapering the initial prednisone dose from 10 mg to 2.5 mg on alternate days helped control the disease in the longer term. This, in turn, helped prevent joint damage and improve the person’s quality of life.

If a person requires long-term treatment, their doctor may prescribe prednisone every other day. However, doctors may recommend daily prednisone treatment during PsA flare-ups.

If a person needs to come off prednisone, their doctor will taper the dosage gradually to prevent withdrawal symptoms.

The higher the dosage of prednisone and the longer a person takes it, the higher the risk of adverse side effects. A lower prednisone dosage of 20 mg or less daily is associated with a decreased risk of side effects.

However, not everyone who takes prednisone will experience side effects. When side effects do occur, they typically disappear as the dosage decreases or the treatment stops.

Common side effects of prednisone include:

According to the Arthritis Foundation and the Canadian Arthritis Society, prednisone may also cause the following side effects:

People can take steps to reduce the risk of certain side effects while taking prednisone. These steps include:

  • eating a nutritious diet and exercising regularly to avoid weight gain
  • taking the medication with food or milk to offset feelings of nausea or indigestion
  • taking the medication in the morning to help reduce the risk of insomnia

Can prednisone make PsA worse?

At the time of writing, there is no reliable, recent evidence to suggest that taking prednisone or another corticosteroid may worsen PsA.

Prednisone may interact with other drugs, supplements, or herbal remedies. These interactions may be harmful or affect how well the medication works.

People who are taking any of the following medications should speak with their doctor before taking prednisone:

People who are taking prednisone should also avoid live vaccines, as prednisone can weaken the immune system.

Learn more about medications that may interact with prednisolone.

A person who is taking prednisone should call their doctor immediately if they experience any of the following:

  • Symptoms of an infection:
  • Symptoms of high blood sugar:
    • sleepiness or confusion
    • excessive thirst or hunger
    • passing urine more often than usual
    • fast breathing
    • fruity-smelling breath
  • Symptoms of Cushing’s syndrome:
    • weight gain in the upper back or belly
    • puffy face
    • severe headaches
    • slow wound healing
  • Symptoms of adrenal gland problems:
    • weight loss
    • nausea
    • vomiting
    • dizziness
    • muscle weakness
    • fatigue
    • mood changes
  • Symptoms of low potassium:
    • muscle pain or weakness
    • cramps
    • abnormal heartbeat
  • Symptoms of pancreas problems:

A person should seek immediate medical attention if they experience any of the following while taking prednisone:

Rarely, prednisone may trigger a serious allergic reaction called anaphylaxis. People who experience any of the following symptoms of anaphylaxis will need emergency medical care:

  • problems with breathing or talking
  • swelling of the face, lips, or throat
  • fast heart rate
  • dizziness or fainting

Prednisone is a corticosteroid medication that helps suppress an overreactive immune system and control inflammation. Doctors may prescribe prednisone to treat a range of autoimmune or inflammatory conditions, including psoriatic arthritis.

In combination with first-line PsA treatments, prednisone can help control joint pain and inflammation and prevent permanent joint damage. Due to these effects, it may ultimately help improve a person’s quality of life.

Prednisone has the potential to cause side effects. Anyone who experiences concerning side effects should seek medical attention as soon as possible to prevent complications.