Can long-term Prednisolone cause severe weight gain?

Question

Hello doctor,

I am 49 and suffer from rheumatoid arthritis. I was prescribed Prednisolone for flare-ups, and it led to weight gain, which was rapid and severe according to my doctor, due to the drug.

What makes weight gain so severe when using Prednisolone for such an extended period of time at 49? Even though I have not changed my diet, my face and my abdomen look different, which influences my self-confidence and leads to my elevated blood sugar level.

Is the weight gain due to using Prednisolone reversible after I stop taking it, or is it irreparable? I am facing a dilemma whether to relieve myself of pain or do something else, as steroid treatment does not seem to be the only one available option.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand the concern.

The fact that you have been controlled by steroids alone implies that your management needs to be optimized. The management of rheumatoid arthritis aims at minimizing or stopping long-term use of steroids through the use of disease-modifying antirheumatic drugs (DMARDs), which include Methotrexate.

If the joint pains recur on reduction or stopping of prednisolone, then it means that methotrexate alone is not enough for your condition. In that case, your rheumatologist might think about including other DMARDs (biologic DMARDs or targeted therapies) in order to control inflammation well enough for steroids to be stopped.

The idea is to totally stop Prednisolone or reduce it as much as possible, but never above 5 milligrams per day when long-term use is unavoidable.

Weight gain in the case of long-term use of Prednisolone is very common. This happens due to the fact that the drug increases your appetite, causes fluid retention, and changes the distribution of fat in your body, which mostly results in facial fat deposition and abdominal fat deposition (moon face). Such changes tend to be reversible upon stopping the steroids, although it takes months.

Do not abruptly discontinue Prednisolone, particularly following prolonged administration, as it may cause adrenal insufficiency. Reduction in dosage must be done gradually, preferably under the guidance of your physician.

I would suggest the following investigations before starting biologic therapy:

Complete blood count (CBC).
Erythrocyte sedimentation rate (ESR).
C-Reactive protein (CRP).
Alanine aminotransferase (ALT).
Aspartate aminotransferase (AST).
Serum creatinine.
Hepatitis C virus antibody (HCV Ab).
Hepatitis B surface antigen (HBsAg).
Human immunodeficiency virus antibody (HIV Ab).
Tuberculin skin test or other tuberculosis screening as recommended.
Chest X-ray.
Hand X-ray.

I would suggest the following treatment:

Continue Methotrexate at a dose to be determined according to the nature of your rheumatology case.
Continue Folic acid supplementation as directed.
Addition of a biological DMARD may also be considered should disease activity persist.
Prednisolone can be tapered gradually, for example, 2.5 milligrams per fortnight once adequate disease control is accomplished.

Preventive measures include adhering to a nutritious and balanced diet. Undertake a physical therapy regimen tailored for rheumatoid arthritis. Test glucose levels, since steroids might exacerbate diabetes and lead to hyperglycemia caused by steroids.

In cases where weight gain and/or elevated glucose levels persist, diabetes mellitus testing and further diagnosis of endocrine diseases may be needed.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.