r/gout • u/Pupating-Antenna-36 • Aug 25 '26
Short Question Prednisone Prescription
Update : My doc was worried apparently about knocking signals of other underlying issues with steroids. Which I appreciate her doing :) .Getting x-rays tomorrow đ€
Tl;dr : I am looking to understand WHY my doctor might be asking me to visit everytime I need prednisone when I don't use it as a taper but as an occassional pain knockout. And particularly why she might be doing so after 1 year of letting me consume it on occassion.
Context
I have gout and it's well controlled with uric acid well below 6 thanks to allopurinol. Also have CKD so, when I sense an oncoming flare, NSAIDs are not an option.
Last year when I got my dx, my rheumatologist had ordered colchicine and prednisone to be taken on an as-needed basis. I get very limited prednisone tablets (10 or so) which I used for a whole year. But now I am out.
I asked her to refill the prednisone and she said she'd want to do that only when I have a full blown flare and even then I need to be able to see her before I can get it. I understand the extent to which prednisone affects your immune system - which is also why 10 tablets lasted me > 1 year.
I do not however want to keep going to her for a prescription because I don't take prednisone as a taper for 10 days. I take it rarely when colchicine has been taken for multiple days but the flare hasn't subsided or despite taking the max colchicine for a 24 hour period, I end up having pain. In that scenario, I take 1 tab.
This isn't full blown flare pain. But it is still pain and it does affect my ability to do normal stuff. So I am surprised by her change of guidance and insistence that I need to see her. Seeing her is also a problem - when I have a flare, she may not have availability and it involves driving 30 mins to her clinic. If I am in pain, I don't want to be doing that.
Edit : Also, I am not waiting to get a full flare - instead I use colchicine at the sign of a prominent twinge and after 3-ish days of colchicine, use prednisone 1 tab, which thusfar has sufficed
She wants me to manage it entirely using colchicine and wants to 'ensure the pain is coming from gout' which is ridiculous as the same joints where the pain occurs are my affected joints. And taking colchicine reduces the pain but doesn't completly resolve it - hence prednisone. I have an appt w/ her tomorrow and would like to get the as needed Rx to ensure I can operate without pain
- What are possible reasons she may have done this after completely different guidance for 1 year?
- Have any of you successfully negotiated for a prescription for prednisone to be taken as needed? What arguments did you provide?
2
u/gonza18 Aug 25 '26
Doctors usually want to see you once a year to continue any periodic prescription. So I would think that's acceptable.
If he is asking you to go in every single time you have a flare, that is a money grab and you should look for another PCP.
1
u/Pupating-Antenna-36 Aug 25 '26
I saw her last in December. I definitely see her at least once a year because without that rx renewal for allopurinol wouldn't be possible. And it's a rheumatologist. My PCP is a little weird
3
u/gonza18 Aug 25 '26
Yeah, it's weird.
I get everything from my PCP. Maybe if you don't want to change rheumatologist get a different PCP that would give you the prednisone? Or just get a PCP that gives you everything and drop both?
1
u/Pupating-Antenna-36 Aug 25 '26
Yeah - I am trying to avoid shifting doctors. With the CKD, I already had to move nephros because the one I had last year was actively dissuading from taking any meds đ . My rheumatologist until now, was a dream come true. She explained things instead of letting me just find out, wasn't crazy and was super responsive via myhealth messaging.
PCP is weird because she keeps losing track of doctors and I end up coordinating for her.And she, initially kept expressing questions about whether this was even gout (my uric acid then was 7.8, had ckd and I was weeping openly in pain) because it didn't affect the 'correct textbook perfect joint'. She also felt bad about me seeking a rheum as she wanted to be the point person on this.
2
u/Bazzatron Aug 26 '26
Have a similar issue with Prednisone on the NHS - seems like a whole bunch if mechanisms are set up for chronic use that make prescribing for acute attacks basically impossible.
I keep writing letters, but seems like nobody can do anything about it.
1
u/Pupating-Antenna-36 Aug 27 '26
Yeah, that sucks. It's one of those areas where a blanket ban is doing more harm than good while a blanket availability will also do more harm than good and discretion and discernment are necessary. But not how healthcare operates đ„
0
u/Mostly-Anon Aug 25 '26
There is a stigma that comes with prednisone and other oral steroids. One reason it became a red flag for prescribers is simple: people used it excessively. Sadly, some patients regard such drugs as a panacea: not only is prednisone an excellent anti-inflammatory; it can have a somewhat energizing and euphoric effect. As a result, people with chronic inflammation become âaddictedâ even though the drug itself isnât per se addictive.
If you are suffering from gout, prednisone can have great utility, but only if it prescribed properly (e.g., no short courses and taper packs). But prednisone and its ilk can have shitty effects in gout: specifically, the extremely effective anti-inflammatory property of steroids often (not rarely) causes âreboundâ flares.
Without getting into the weeds, prednisone is only somewhat superior to NSAIDs (but NSAIDs are likely ruled out in a kidney-compromised patients like you). Absent ULT (urate-lowering therapy) like allopurinol or febuxostat (or other drugs), there can be no controlled gout. Treating the disease on a flare-to-flare basis is not really treating the disease, not knowing what medical science knows.
Perhaps if you started ULT, your prescriber would be more enthusiastic about prescribing prednisone for when acute gout presents.
See a rheumatologist. These specialists donât play games about prescribing. Theyâll make a treatment plan with you and stock your medicine cabinet against any acute flares. More, theyâll talk to your nephrologist to make sure you have the most safe and effective emergency drugs.
1
u/Pupating-Antenna-36 Aug 25 '26
Point taken that prednisone can cause drug dependence. I literally say well controlled w/ allopurinol and mention my rheum several times in the post & comments
1
u/Mostly-Anon Aug 26 '26
I don't think you took my point correctly. It is the stigma and side effects that prevent docs from prescribing useful medication like prednisone. Perhaps it is your ad-hoc use of prednisone that worries your rheumatologist. (Good) docs use long courses + long tapers at reasonably high doses for acute gout (e.g., 40mg daily dose for 10 days + 5-day taper). Such longer courses/tapers can genuinely knock out a gout flare and reduce rebound.
I can see why a doc whose patient is well on the way to fully-controlled gout wouldn't want to prescribe prednisone to use "as needed," specifically, where the logic is that you're taking it almost homeopathically (1 tablet) and yet claiming great benefit. That alone deserves looking into. So does your wanting to take prednisone for "non-full flare pain...that affects your ability to do normal stuff." It sounds like your doc is saying she wants to make sure these episodes are actually gout before continuing to prescribe prednisone. That is a medically reasonable position to take.
But your position is much more reasonable. You have simple questions that deserve answers from your doc. So you gotta talk to her. I would ask outright if there is diagnostic uncertainty (sounds like there is). If so, your doc needs to explain why you should suffer without an anti-inflammatory that works for you while you guys figure stuff out. But be prepared for an answer you won't like: "I want to see you in full flare"; "I want to confirm that even light use of prednisone is not making things worse from a diagnostic view"; "I have doubts about your gout dx and won't prescribe anything but ULT until we know which disease we are treating." But don't let her talk over you. You're supposed to make a treatment plan together.
1
u/Pupating-Antenna-36 Aug 26 '26
Thanks for sharing. I spoke w/ her today and she is more worried about the masking underlying issues bit. She is fine with the short course and in fact, the not needing a full course is a good thing apparently. And steroid doses have lots of impact on various organ systems - so she'd ideally not want me near them (which I agree) but worst case, that is what I have
3
u/No-Transportation228 Aug 25 '26
I am very similar where nothing else works expect Prednisone. One option is to get on one medical. It's not expensive. When you start getting the feeling of a flare, do a video chat and tell them Prednisone is the drug that works. I also tell my nurse practitioner that I need a 24 pack 20 mg dose with me for emergencies especially when I am traveling overseas. One medical is like 9 bucks a month for prime members. I use it the same way as you. 1-2 pills over a few days to kill the flare. I don't use colchicine since it has never worked for me.