Prednisolone (Rheumatology)

How it works

It is a synthetic corticosteroid that binds the glucocorticoid receptor to suppress pro-inflammatory gene transcription and immune cell activity, producing broad anti-inflammatory and immunosuppressive effects.

Prescribing in practice

• Never stop long-term or higher-dose therapy abruptly because of the risk of adrenal insufficiency — taper gradually and issue a steroid emergency card with advice to increase the dose during intercurrent illness.
• Prolonged use causes osteoporosis, so assess fracture risk and offer bone protection in line with NICE guidance, alongside vigilance for hyperglycaemia, hypertension and infection.
• It increases susceptibility to infection and can mask its signs, and live vaccines should generally be avoided at immunosuppressive doses.

Monitoring

Monitor blood pressure, weight, blood glucose and bone health on longer courses, and review for infection, mood change and gastrointestinal symptoms at follow-up.

Counselling the patient

• Do not stop suddenly and carry your steroid card at all times.
• Take it in the morning, ideally with food.
• Seek advice promptly if you feel unwell or develop an infection.

Evidence & guidelines

Glucocorticoids are long-established and trial-supported in rheumatology, with giant cell arteritis being a clear example where prompt prednisolone prevents visual loss.