Prednisone prescribing for rheumatoid arthritis management in primary care

A: “I was crashing really bad to the point that I didn’t know if I could even keep working, if I had to go on leave, and [my FP] offered me prednisone. And I said no at that point, just because I was 2 weeks away from seeing the rheumatologist.” (Female 01)

B: “There was still a lot of pain, especially through the night…. When I went to my GP, I told him and he said, ‘Why don’t we up the dosage a little bit here. Feel free to go higher in the dosage of the prednisone.’ And so I increased the dosage.” (Male 01)

C: “Before I [saw] the rheumatologist, I ended up in [the] emerge[ncy department]. They prescribed prednisone, but just for 5 days.... I got in within 3 weeks, but only because I impressed on them the desperation of my situation. At least the rheumatologist was able to prescribe more prednisone.” (Female 02)

D: “The pain got so bad that I was contemplating some bad things, so if this keeps me away from that scenario, I’m gonna do what I have to do.” (Female 03)

E: One patient (Female 04) obtained prednisone without a prescription while abroad when health insurance was unaffordable.

F: “It was that sort of 2-year period, and I was on incredibly high doses of prednisone, like 110 mg. It took 2 years to get off the prednisone. I had to be weaned off it so slowly.” (Female 05, suspected of having polymyalgia before RA diagnosed)

G: “It was about a year [to get to a rheumatologist from the FP]. And so first [the FP] put me on prednisone. And that was really good. But I really was concerned about staying on prednisone and then by the time I had come off, you have to come off of it gradually, I then saw the rheumatologist.” (Female 06)

H: “I don’t feel great about giving prednisone for long-term because we know there’s risks to that too, so we’re trying to balance the risks and benefits.” (FP1, FG1)

I: “I just recently had a new diagnosis of RA with, ‘light up like a Christmas tree’ markers and I was really quite disappointed in my access to rheum[atology]. I sent an urgent referral, I followed up with a phone call, said please put this in front of your triaging physician they’re going to want to see them quickly.… Their waitlist was 6 to 8 months. I picked up the phone again and said, ‘No, I’m sorry,’ and had to go through ConnectMD to speak to the rheumatologist. [I] said, ‘Forgive me if I’m wrong, but these are the people you want to see.’ He replied, ‘No, absolutely we need to see this person within a few weeks!’” (FP2, FG2)

J: “It was going to be 2 months before [my patient] was seen [by a rheumatologist] and she was not functioning, and could not take care of herself at home, so I gave her a week of prednisone.… [After which] she was feeling better, but the next week she had a flare of her symptoms again, so I called Specialist Link and asked them for some advice and … they gave me some instructions about starting Plaquenil until she was seen.” (FP3, FG1)