Most anti rheumatic medications take weeks if not months to begin working. When patients are not doing well, it is often advisable to use a steroid like Prednisone. Steroids work very rapidly and can bring about rapid and dramatic improvement in almost all rheumatic or auto immune conditions.

Steroids do have associated risks. These include weight gain, thin skin, osteoporosis, infections, damage to certain bones especially the hip. Worsoning of diabetes, and emotional or psychatric side effects.

Despite the long list of possible risks, most people tolerate the medication very well and notice only the dramatic relief of pain and swelling etc.

When taking steroids, you should also take Calcium with Vitamin D to protect the bones.

What is the propper dose of steroids, and how do you taper them? There is no cook book answer. Some general rules are to use higher dosed for short times (3-5 days) to "put out the fire". Then lower doses. When improvement is good we can try to taper the steroids. Generally this means lowering the dose every 2 to 4 weeks, by cutting the dose approximately 10 to 25%. This means when a patient is on high doses you can cut larger amounts of milligrams than when on lower doses.

In general, doses of 7.5 milligrams or less daily are tolerated for long periods of time well. Doses of 15mg and up less so, and doses of 30mg or more usually do have weight gain and other side effects. Sometimes steroids are needed to save life when vital organs such as kidneys, lungs or brain are effected from Lupus or Vasculitis.