Mary is a 48-year-old woman with severe rheumatoid arthritis. Her pain is no longer controlled by aspirin and her physician ordered 5 mg prednisone three times a day

Mary is a 48-year-old woman with severe rheumatoid arthritis. Her pain is no longer controlled by aspirin and her physician ordered 5 mg prednisone three times a day. Over the next 4 weeks, Mary’s symptoms were markedly improved and she became more mobile again. She also noted that for the first time in years she felt “really good.” Her appetite increased, she was no longer fatigued, and her outlook on life was markedly improved. At her follow-up visit, Mary had gained 9 pounds: she had slight edema in both ankles, and her blood pressure was 150/92 mmHg. An inflamed, oozing lesion was found on her right hand, which she stated became infected a few weeks ago after she cut her hand. The physician decided that Mary was past her crisis and that the prednisone should be tapered to 5 mg/day over a 4 week period.

  1. What effects did the prednisone have on the process at work in Mary’s joints and what effects did the corticosteroids have on the rest of her body?
  2. What teaching points should be included in a plan of care for Mary?

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