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Living with Psoriatic Arthritis (PsA)

Dosages for Meloxicam and Prednisone

I am curious as I have caught hints about how Meloxicam and Prednisone dosage protocol and whether there is some sort of standard while taking one or both and what the dosage is. I would like to hear for those that do not mind sharing, if these are taken together, what are the maximum dosages either alone or together and whether there is a global consensus related to the symptoms that are being treated. For example, I am instructed to take 15mg predinsone a day plus 22.5 meloxicam daily. I would like to know depending on flares or symptoms what is a maintenance dosage and then what is a flare dosage. Thanks for the feedback. It would be good if you response if you could outline the severity of psa symptoms and how long it has been treated or in the picture. Thanks.

I am also curious to know if psa can be treated successfully by either one of these drugs. Are there any studies that show the success of nsaids and prednisone in treating psa vs biologics? Currently I am taking all the above and I am just curious to know how effective prednisone and nsaid treatment alone can slow the disease.

I just read your last paragraph and screamed ‘NO!!!’. (Then I read the first one too).

When I first got my diagnosis, the one and only thing I could recall about inflammatory arthritis was an item on the radio in which a retired nurse recalled treating an old lady with rheumatoid arthritis. She was haunted by the lady’s screams of pain as the nurses tried to unlock her stiffened, rigid knees. That would have been back in the day when steroids were the main line of treatment. As the whole subject has become more familiar, I’ve met several people with family members who died of heart attacks having had inflammatory arthritis treated predominantly with very long-term steroids. They have limitations. They incur risks. As I understand it, research also backs up my thinking that long-term use of steroids is highly undesirable.

NSAIDs … similar scenario. Good rescue remedy or prop, bad news for the body as a whole, especially the digestive system, if used long-term.

Having said all that, I recall tntlamb indicating that there may be some re-evaluation of the usefulness of steroids. Like so many things, the subject may be rather more complex than the current widely received wisdom. But proceed with great caution.

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I’m almost never on an nsaid and prednisone. That said, I was recently on ibuprofen and prednisone to try to beat down a flare. I was already on 600mg of ibuprofen 3 times a day. I added in 20mg of prednisone with a decrease of 5mg per week.

In terms of controlling the disease, long term use of prednisone above 10mg a day (I think) has side effects, and the combination won’t slow progress of the disease.

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Thank you both. Just wondering when in flare what the routine doses are for each and for how long. It seems that I have read values ranging from high to low on both. I do not plan on stopping biologics or anything but was wondering about the latest medical thought regarding if inflammation throughout the body and how that relates to joints. Say perhaps you had enthesitis and spondylitis. I am thinking based on symptoms and common joints that I think I may have this. Call it a strong intuition. I am going to bring this up with my doctor. But if an individual had psa with these two things going on you would think that taking all the above would be helpful. I really love my meloxicam alot. It makes a huge difference. Steriods make me hungry and feel a little off but I figure it is helpful. I guess the question is how long should one use either one or both vs. the benefits and cons.

I have not used steroids doses at 5-15mg for long periods of time but have during flares for a week or two at a time, maybe a bit longer in some cases. This last prednisone is more for treating inflammation in the digestive tract and I am going on almost 3 weeks. Anyone with knowledge or personal experience feel free to share. Kinda of just wondering if it slows any part of the disease to some degree. It seems like it would do something to disrupt damage but maybe not.

I tend to be prescribed pred for ‘issues’. Those issues being when a med stops working as I seem not to do ‘flares’. I slowly get better when a med works and slowly get worse when it’s decided to stop or more likely my disease progression outstrips it.

But it’s never long term pred never more than a couple of weeks really. Start at 20mg or preferably 15mg and slowly work down. I do however take NSAIDS daily presently I’m on arcoxia and max dose of that is 90mgs. I get it prescribed at 30mgs so I can decide how much of it I want every day, 30mgs, 60 mgs, or 90mgs.

I don’t think either or both do anything for disease progression or disease halting. I simply think they ease the present symptoms, the symptoms returning as soon as either or both are dialled down if nothing else as in a a biologic or DMARD isn’t starting to work.

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You’re asking if prednisone is disease modifying. I don’t know … I think it may be. But the point remains that we need ongoing disease control to limit progression.

Here in the UK we sometimes get given steroid shots in the backside. The effect lasts for up to 3 months or so. The resulting greater overall ease of movement is good for joints and good for morale, so yes, definitely helpful. I doubt anyone would say that steroids and NSAIDs are not helpful when used advisedly.

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I really apologise for not having the link to the study - if you are keen for it then perhaps tag TNTlamb, but there has, in recent years, been some evidence that shows that steroids, within a short term of diagnosis (like 3months), can have a mild DMARD effect.

My memory is that it is extremely mild, and it effectively “runs out” within 3 months of steroid use. So to be effective (even mildly), you need to be in the first 3 months of diagnosis, then it’s only mildly effective for a few months - but does require systemic use for around 3 months, which has its whole range of side effects.

Further, the level of steroids that are harmful systemically, is unfortunately only 5-7mg daily. Frankly it’s a tiny dose in the context of moderate arthritis- an even tinier one for IBD.

I gather you are on biologics, and they are your DMARD. Steroids and NSAIDS occasionally as a rescue from a flare are fine. But honestly, if I find myself “rescuing” myself more than once every couple of months, then it’s really worth reviewing baseline medication.

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Regular Low dose steroid (usually 5 -7.5mg) have generally been found to be okay… As far as a flare protocol depends on where your Doc went to school. They take one of two forms a Burst or a Tapers. Dosage is (or should be) based on the individual and previous response) A burst is usually 3 days and a taper 6 days.

There is also a newer protocol that starts with 2 days of Higher dose NSAIDs and Tylenol followed by 3 days of Predi 1X daily (20 -30mg) It is rapidly overtaking the other two.

FWIW all use of Prednisone is a low dose with PsA. What flows through these boards is someone taking 30mg is loaded and folks start freaking… For PsA perhaps. For asthma they start at 60 or more.

That being said the use of Steroids is VERY complicated and NEVER routine. Predi can cause Congestive Heart Failure. I have Congestive Heart failure which when it flares also leads to Afib which has blessed me with a stroke. Prednisone can rapidly eliminate volume overload and improve clinical status and renal function in CHF. So the thing that can cause my heart issues can fix, rapidly, the heart issues We are talking A LOT of predi given IV.

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Thank you tntlamb. Good info. to have. Thanks all for your posts.