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Did prednisolone affect my recovery after heart surgery?

Q) I’m a rheumatoid arthritis sufferer of about 20 years, on prednisolone and methotrexate. I recently had a coronary followed by two procedures for angioplasty and a heart bypass. I believe I suffered a slower recovery because the management of my prednisolone post-operatively could have been handled better. Could you comment?
M. Childs, Kent (Winter 2010)

A) It's difficult to comment as you don’t say in what way you think the dosage of prednisolone could have been altered for the better. Some doctors believe that methotrexate should be stopped during operations and such like as it may delay healing, but clinical trials have shown no basis for this. Steroids, including prednisolone, should be increased during times of physical stress and then tapered to their former dose when the stress is over. A heart attack, or coronary, is just one example of such stress, and an operation would be another. Why do you need more steroid during times of physical stress? Normally your body produces more of these naturally occurring hormones during such periods, but if you've been on steroids for some time the body is less able to respond. In these cases, we artificially increase the dose of steroid to do the job the body would normally do.

This answer was provided by Dr Philip Helliwell for the Winter 2010 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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