Can the use of methylprednisolone for RA affect fertility?

Hello,

Welcome to icliniq.com.

I understand your concern.

Well, it is a tough spot you are in. It will be difficult for a new rheumatologist to diagnose if you are already on steroids and the symptoms get masked. But I will try to simplify it for you here. Could you let me know the results of the rheumatoid factor, anti-CCP antibody, and ANA? If they are negative, it will reduce the probability of rheumatoid arthritis.

Steroids are always harmful in the long term. They can cause cataracts, osteoporosis, and diabetes mellitus. They are like drugs that cannot be withdrawn easily. So, to figure out if it is rheumatoid or not, the first thing is serology (a blood test is advised). The second is to get an ultrasound of the joints done. It will help us detect if there is anything underlying. Either way, steroids are not an option for you.

You will have to put in a lot of effort to get off it. Your doctor may have to give you a steroid-sparing agent for a short course to help you come off it. Steroids as such do not cause difficulty in pregnancy, but they do cross the placenta if taken at higher doses and may affect the baby. So, we have to get you off it and streamline your treatment. Firstly, whether it is rheumatoid or not, and secondly, what medications do you need?

I hope this information is helpful.

Please do not hesitate to contact me if you need to know anything else; I would be happy to answer.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Long-term steroids are not an option at your age. We only use them for lupus or vasculitis, and that is also at a minimum dose (that would be 2 mg once every three days). So, we need to stop using them. To reduce the dose, I would suggest taking 4 mg one day and 2 mg the other day for three weeks, then reducing it to 2 mg daily for the next three weeks, and then 2 mg on alternate days.

Consult your specialist doctor, discuss with him or her, and start taking the medicines with their consent. When you take steroids from outside, your body stops producing the steroid hormone, which is our main stress hormone, and we need to stimulate the body to produce it again. So, it usually takes around three weeks (after we make it on alternate days, that is) to start producing again. So, that period is tough with a lot of pain, and you will have to manage it with safer painkillers like Tylenol or Paracetamol.

The bruising you are mentioning is due to long-term steroid use. It weakens the normal skin structure, and they start getting bruised for no reason. So, it is one of the side effects. As per your blood test, the disease does not look very active. But if you fear the joints will swell up on tapering steroids, I would suggest letting that be.

As rheumatologists, we are more comfortable starting you on proper treatment, such as Methotrexate or Sulphasalazine, when we see these swollen joints than when the swelling is hidden due to a steroid. The moment they swell up, keep an early appointment with a rheumatologist and let them start you on the treatment they feel will benefit you.

I hope the information was helpful.

Thank you.

Hello,

Welcome back to icliniq.com.

Well, if the joints are swelling up and pain is coming back on tapering Medrol, then it is time to step up your medicines.

For now, do not reduce Medrol further till your rheumatologist sees you and is convinced that joint inflammation is back. But try to schedule an appointment early before the disease jumps up more. There is a possibility that Methotrexate 20 mg alone is not working for you. You were having good control on steroids, but since that was giving you side effects in the long run, we need to add another substitute. 60 percent of people are well controlled on a single drug.

But if your swelling is coming back, we need to add the next line, like Sulphasalazine or Hydroxychloroquine (that depends on the outcome of your joint examination and lab reports). Well, for the last part, it is a bit tough for me to guide you to a rheumatologist around your place.

You can always ask your rheumatologist to seek another opinion, and they would be more than happy to help you. Also, please get these blood tests repeated:

1. CRP (C-reactive protein).

2. ESR (erythrocyte sedimentation rate).

3. Liver function tests.

4. CBC (complete blood count).

Kindly update me with the results.

I hope this was helpful.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Well, it is good to know you are doing well, even with a lower dose of Medrol.

Bruising as such is usually caused by Medrol only, as it weakens the skin tissue. But if you could send a picture, it would be helpful. Just want to be sure there are no varicose veins. Methotrexate does not cause bruising as a side effect. We can reduce the dose since you are doing well on Methotrexate 15. If any swelling comes up, we can also increase methotrexate to 20 mg.

Recommended dose is 2 mg Medrol twice a week, and then gradually go off after four to six weeks. For bruising, start on a vitamin C supplement, which helps strengthen the capillaries. But do check for varicose veins, as treatment will differ.

I hope this was helpful.

Thank you.

Hello,

Welcome back to icliniq.com.

Well, I think it is time we taper your Medrol. If you experience joint swelling, show it to your doctor, so we are sure it is arthritis only, which is coming back, and we can step up the dose of Methotrexate.

I have reviewed the pictures (the attachment was removed to protect the patient's identity). The bruising is immense. Also, a lot of varicose veins can be seen. Did you ever do a venous Doppler for your lower limbs?

As such, we do not expect it at your age. Also, we need to see your other tests for clots, like PT, APTT, and INR, to be sure it is not something else we are missing. Vitamin C is known to help this capillary breakdown and prevent bruises, so it is worth a try. Do let me know if you have these couple of queries.

I hope this was helpful.

Thank you.

Hello,

Welcome back to icliniq.com.

Well, it is great to know you are almost off steroids. Well, 2 mg a dose is as good as not being on them, as our body produces more daily steroids. I guess you can stop it over the next couple of weeks. I have reviewed the images (attachment removed to protect the patient's identity), and the pigmentation is quite extensive.

I suggest getting a venous doppler first to be sure the veins are not causing such pigments. Then, you will have to seek an opinion from a dermatologist. I am unsure how much they can help remove it, but maybe lighten it. But we need to see why it is happening. So, I would suggest going off Medrol and getting a venous doppler. If the Doppler is normal, you seek an appointment with a dermatologist.

I hope this information is helpful.

Please do not hesitate to contact me if you need to know anything else; I would be happy to answer.

Thank you.