Doc: Temporal arteritis requires long-term prednisone
Dear Dr. Roach: I was diagnosed in March 2015 with giant cell arteritis. I was started on 60 mg of prednisone, but it has decreased steadily and I am now on 5 mg. Can you tell me what prednisone does that’s harmful to the body? I hear not to take it long term, but I might have to.
Dear D.M.R.: Prednisone does indeed cause many problems to the body if taken long term. I could fill many pages with possible side effects, but among the most serious are diabetes, high blood pressure, poor wound healing, psychosis, osteoporosis and suppression of the body’s ability to make its own steroid — cortisol, which can predispose people to developing the life-threatening condition called Addison’s disease.
But as you said, you might have to, because as bad as taking long-term prednisone is, sometimes NOT taking it is worse. Giant cell arteritis, also called temporal arteritis, causes headaches and may cause jaw pain when chewing. Moreover, in some people it causes visual changes, which can lead to permanent blindness. Prednisone is very effective at treating this condition, and most people are on prednisone for over a year.
Prednisone has been used for many autoimmune and inflammatory conditions, but the trend in the past 20 years has been to find therapies that are more effective and have less potential for side effects. In many cases, there are now good alternatives. Unfortunately, that isn’t always the case, and it’s always important to weigh the risk of taking a medicine against the risk of not taking a medicine. Nobody should be taking a medicine as powerful and dangerous as prednisone, particularly high-dose prednisone, without very careful and ongoing consideration of its continued necessity.
In giant cell arteritis, there is no good alternative, and the prednisone dose needs to be tapered off slowly to prevent recurrence or flare-up of the condition. This requires a seasoned clinician.
Dear Dr. Roach: I’ve read many times in your answers that you recommend fresh fruit. I have no luck buying fresh fruit, even at the farmer’s market. So, for the past few years I’ve been eating canned peaches and pineapple. I rinse off the light syrup under cold water. Do I get the health benefits of fresh fruit this way?
Dear P.K.: Nowadays, fruit is available year-round in many cases, thanks to Southern Hemisphere growing seasons and the ability to store some fruit for prolonged periods. Some fruits, like bananas and pineapples, are shipped from places where they are grown at all seasons. However, buying your fresh fruit in season at a farmer’s market, specialty produce market or directly from a farmer gives you the best chance of getting excellent quality.
Frozen fruit is a reasonable choice for some recipes, like smoothies. Canned fruit is a last resort, and I do recommend rinsing off the syrup or purchasing fruit packed in juice. I also would recommend varying what you eat. Apples and pears, berries, stone fruits, grapes and tropical fruits all have benefits, and it’s best to have diversity in your diet.
Email questions to ToYourGoodHealth@med.cornell.edu.