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Methylprednisolone and RA

RA Just sayinMethylprednisolone (WOW, an impressive word!) is served up in a package of 21 four milligram (mg) pills (Medrol Dose Pak) with specific instructions as to when to take each pill. One time a nurse told me to start the pack the next day as the instructions start before breakfast and that would be the only way I could follow the instructions. I would have to wait through the night before I could start resolving my problem.

This time around I saw written on the package that all six tablets in the first row for the first day should be taken on the day you receive your prescription even though you may not receive it until late in the day. All 6 pills may be taken at once on the first day or divided into doses for the remainder of the day.

I have had this prescription twice for inflamed salivary glands after thyroid cancer treatment and twice for RA flares. I call it a miracle drug as it is so effective. My joints still hurt when I get out of bed in the morning, but I feel a lot better. Joint swelling is minimal. Pain is minimal. I have renewed energy. I feel human again.

I normally take 5mg prednisone daily. So I was wondering what the equivalent strength of methylprednisolone was to regular prednisone.

5mg prednisone is equal to 4mg methylprednisolone.

There are equivalent calculators on the internet. Google it. So on the first day of my Medrol Dose Pak I was taking 30 mg of prednisone. Not so bad. The last day I am back to my normal of 5 mg.

My doctor says I manage my RA well. I appreciate her feedback. It is a tough disease. It is long and persistent as are many others. It doesn’t happen suddenly. Then you are treated and then you are done with it. It is something that is lived with for the long haul with all its ups and downs. I appreciate having tools such as the Medrol Pak for times of need. The RA toolbox has many tools and the Medrol Pak is a good one to have in it.

RA and Malnutrition



A COMMON BUT LITTLE KNOWN complication of RA is malnutrition.  In fact, it is estimated that more than 40% of Rheumatoid Arthritis patients are malnourished.

My first thought would be that RA can cause such overwhelming fatigue and pain that it would be difficult to muster the energy to prepare and then eat a meal. Just to make a sandwich requires unwrapping the bread, putting the slices on a plate, wrapping the bread bag back up, opening containers and adding spreads, meat or veggies, closing containers, putting them away. Sitting down at the table with your sandwich and eating it. Sounds easy enough. But if you are so wiped out by the extreme fatigue of RA or your hands are swollen and ache deeply in a way that is hard to explain, making a sandwich can be an overwhelming task. It is a task that can be skipped. And it frequently is. Additionally, it is difficult to rally the energy to go to the grocery store, get out of the car, walk in,  select items, pay for them, go back to the car, put the groceries in, get in yourself, drive home, carry the groceries inside, and put them away. Exhausting thought. Nap time.

Next on my personal list of why RA patients are malnourished are drugs. Many of the DMARDs (Disease Modifying Anti-Rheumatic Drugs) have side effects. Some of them go away once your body becomes accustomed to the drug, others don’t.  Nausea is a big one on my list. I am thinking of my friend, methotrexate. I do believe most of the DMARDs can cause nausea.  Mine comes and goes. Now I give myself methotrexate by injection and with the dose tweaked down by 2.5mg, I usually don’t have any nausea.  When I started methotrexate, diarrhea as well as nausea were big problems. It is better for me now. Nausea, alone, is enough to kill an appetite and it is no help for food shopping success.

Doctors add protein wasting to our list of why RA patients become malnourished.  The chronic inflammation that RA sufferers endure produces chemicals that interfere with metabolism and causes muscle wasting and then muscle weakness. Muscle strength weakens.   Loss of grip strength is an example. This wasting does not occur in the fatty tissue. The fat may stay as the muscles become flabby. Doesn’t seem fair. Those with muscle wasting may look plump enough but their muscles are deteriorating. Moving them in the direction of a downward spiral.

Understand that eating a balanced diet is as important as taking your drugs. Moving those muscles is important, too. The how-to is a little more challenging.

RA treatment drugs can cause nutrient deficiencies. Folic acid is a necessary  supplement when taking methotrexate. A B vitamin complex is helpful. Calcium and vitamin D are especially helpful for those on corticosteroids or not. RA patients are at increased risk for osteoporosis in any case. Antioxidants, such as vitamin C, are also important.

There is more but this is enough for now. Think fish oil. No, don’t think that. Think juicy, fresh strawberries, slices of Havarti, bread that is fresh and crusty. An afternoon nap. That’s where I am headed.

RA nodules

nodulesRheumatoid nodules are commonly talked about when rheumatoid arthritis (RA) is discussed. It might surprise you to know that only 7% of those newly diagnosed with RA have rheumatoid nodules. So they are not characteristic symptoms of newly diagnosed RA.

Photo: Medical Dictionary, © 2009 Farlex and Partners

Overtime, about 25% of those with positive Rheumatoid Factor (RF) develop nodules. Nodules are frequently present in the more severe cases of RA, those more likely to have rapid progression of joint destruction and to develop vasculitis.  75% of those with Felty’s syndrome, more common in white males, have rheumatoid nodules. Current smokers with RA plus nodules usually have more severe disease.

In those with seronegative rheumatoid arthritis, about 6% develop rheumatoid nodules.

The condition of having rheumatoid nodules is called rheumatoid nodulosis.

  • The nodules form below the skin near joints.
  • They are firm and frequently moveable.
  • They are not tender and are not usually harmful.
  • They are 2 mm (.008 inch) to 5 cm (2 inch) and may occur singly or in clusters.
  • They are formed in three, under the microscope, stages:
    • acute inflammation (not like the inflammation found in joints.)
    • granulomatous
    • necrotic where the central tissue in the nodule dies. There is risk of infection and ulceration.
  • Severity of the nodules is related to joint erosions and other severe features of RA. Genes play a role in the appearance of nodules.

Common sites for rheumatoid nodules are bony prominences

  • hands, elbows, forearm, fingers
  • hip prominences
  • joints of feet
  • back of head, heels, Achilles tendons, ears, penis, vulva

Those wheel chair bound or bed ridden may develop nodules over the low back and buttocks.

Rare sites

  • lining of the lungs, the lungs
  • lining of the heart
  • lining of the abdomen
  • bones
  • vocal cords
  • trachea
  • liver
  • pancreas
  • kidney
  • CNS
  • kidney


About 8% of those receiving methotrexate treatment develop micro-nodules (<.5 cm). They are small, multiple and commonly seen around the finger joints. The reason is unknown. They are also associated with Imuran, Enbrel and Arava.

When the nodes are compressing a nerve or causing tissue damage because of their location, the nodules may be excised.