Q: My 57 years old wife is suffering from rheumatoid arthritis for the last 9 years. The hakim gave her some unknown tablets for pain relief 7 years ago, which worked immediately. Since then she is taking those tablets. I suspect that these tablets contain Prednisolone-a steroid. Now she has become obese with flabby-loose muscles and has developed fluid-water retention and childish behaviour. She is unable to leave those tabs despite sincere efforts because of severe body pain, tiredness and depression. How can she stop taking those tabs?

A:Rheumatoid arthritis is a chronic disorder. The first line treatment is aspirin though many other therapies are available. While painkillers are routinely used, some new "Disease Modifying Drugs" have now become available. Steroids are used for short durations to tackle acute exacerbations. Long-term use leads to many side effects such as water retention, high blood pressure, diabetes, etc. Since the real ingredients of the unmarked tablets given by a hakim are unknown, you can attempt to substitute them with prednisolone (Wysolone) 5 mg twice daily (10mg per day) for about two weeks, and then gradually reduce the dose to 7.5 mg, 5mg and 2.5mg daily at two-three weekly reductions. To take care of pain and stiffness, Eclonac-P (aceclofenac with Paracetamol) 1 tab twice or thrice daily can be given.