- Rheumatoid Arthritis Slideshow Pictures
- Take the RA Quiz
- Joint-Friendly Exercises to Reduce RA Pain Slideshow
What is prednisone? How does it work?
Prednisone is a drug that belongs to the corticosteroid drug class, and is an anti-inflammatory and immune system suppressant. It's used to treat a variety of diseases and conditions, for example: inflammatory bowel disease (Crohn's disease and ulcerative colitis), lupus, asthma, cancers, and several types of arthritis.
Common side effects are weight gain, headache, fluid retention, and muscle weakness. Other effects and adverse events include glaucoma, cataracts, obesity, facial hair growth, moon face, and growth retardation in children. This medicine also causes psychiatric problems, for example: depression, insomnia, mood swings, personality changes, and psychotic behavior. Serious side effects include reactions to diabetes drugs, infections, and necrosis of the hips and joints.
Corticosteroids like prednisone, have many drug interactions; examples include: estrogens, phenytoin (Dilantin), diuretics, warfarin (Coumadin, Jantoven), alcohol, and diabetes drugs. Prednisone is available as tablets of 1, 2.5, 10, 20, and 50 mg; extended release tablets of 1, 2, and 5mg; and oral solution of 5mg/5ml. It's use during the first trimester of pregnancy may cause cleft palate. This medicine is secreted in breast milk and can cause side effects in infants who are nursing. You should not stop taking prednisone abruptly because it can cause withdrawal symptoms and adrenal failure. Talk with your doctor, pharmacist, or other medical professional if you have questions about prednisone.
If you notice other effects not listed above, contact your doctor or pharmacist. In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire prednisone consumer monograph >>
What are the side effects and adverse effects of prednisone?
Side effects of prednisone and other corticosteroids range from mild annoyances to serious, irreversible organ damage, and they occur more frequently with higher doses and more prolonged treatment.
Common side effects include:
- Retention of sodium (salt) and fluid
- Weight gain
- High blood pressure
- Loss of potassium
- Muscle weakness
- Thinning skin
- Problems sleeping
Read the entire prednisone consumer monograph >>
What are the serious side effects of prednisone?
- Puffiness of the face (moon face)
- Growth of facial hair
- Thinning and easy bruising of the skin
- Impaired wound healing
- Ulcers in the stomach and duodenum
- Worsening of diabetes
- Irregular menses
- Rounding of the upper back ("buffalo hump")
- Retardation of growth in children
- Anaphylaxis (severe allergic reactions like hives, itching, skin rash, swollen lips/tongue/face)
- Vision changes
- Congestive heart failure
- Heart attack
- Pulmonary edema
- Allergic dermatitis
- Low blood pressure
- Amenorrhea (lack of menstruation)
- Newly onset diabetes
- This drug also causes psychiatric disturbances, which include:
- Mood swings
- Personality changes
- Psychotic behavior
Latest Arthritis News
Daily Health News
What are other possible serious side effects and adverse events?
Other possible serious side effects of prednisone.
Prednisone and diabetes: Prednisone is associated with new onset or manifestations of latent diabetes, and worsening of diabetes. Diabetics may require higher doses of diabetes medications while taking prednisone.
Allergic reaction: Some people may develop a severe allergic reaction (anaphylaxis) to prednisone that includes swelling of the airways (angioedema) that may result in shortness of breath or airway blockage.
Immune suppression: Prednisone suppresses the immune system and, therefore, increases the frequency or severity of infections and decreases the effectiveness of vaccines and antibiotics.
Osteoporosis: Prednisone may cause osteoporosis that results in fractures of bones. Patients taking long-term prednisone often receive supplements of calcium and vitamin D to counteract the effects on bones. Calcium and vitamin D probably are not enough, however, and treatment with bisphosphonates such as alendronate (Fosamax) and risedronate (Actonel) may be necessary. Calcitonin (Miacalcin) also is effective. The development of osteoporosis and the need for treatment can be monitored using bone density scans.
Adrenal insufficiency and weaning off prednisone: Prolonged use of prednisone and other corticosteroids causes the adrenal glands to atrophy (shrink) and stop producing the body's natural corticosteroid, cortisol.
Necrosis of hips and joints: A serious complication of long-term use of corticosteroids is aseptic necrosis of the hip joints. Aseptic necrosis is a condition in which there is death and degeneration of the hip bone. It is a painful condition that ultimately can lead to the need for surgical replacement of the hip. Aseptic necrosis also has been reported in the knee joints. The estimated incidence of aseptic necrosis among long-term users of corticosteroids is 3%-4%. Patients taking corticosteroids who develop pain in the hips or knees should report the pain to their doctors promptly.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or Health Canada at 1-866-234-2345.
Read the entire prednisone consumer monograph >>
Other consumer prednisone side effects*
SIDE EFFECTS: Nausea, vomiting, loss of appetite, heartburn, trouble sleeping, increased sweating, or acne may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if any of these unlikely but serious side effects occur:
- muscle pain/cramps,
- irregular heartbeat,
- swelling hands/ankles/feet,
- unusual weight gain,
- signs of infection (such as fever, persistent sore throat),
- vision problems (such as blurred vision),
- vomit that looks like coffee grounds,
- black/bloody stools,
- severe stomach/abdominal pain,
- mental/mood changes (such as depression, mood swings, agitation),
- slow wound healing,
- thinning skin,
- bone pain,
- menstrual period changes,
- puffy face,
- easy bruising/bleeding.
This medication may infrequently make your blood sugar level rise, which can cause or worsen diabetes. Tell your doctor right away if you develop symptoms of high blood sugar, such as increased thirst and urination. If you already have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication, exercise program, or diet.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the U.S. -- call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. In Canada -- call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire consumer prednisone drug information >>
Prednisone is an anti-inflammatory and immune system suppressant drug that belongs to the corticosteroid drug class. Prednisone is used to treat a variety of diseases and conditions of the skin, gut, lungs, endocrine system, eyes, and blood. Examples include inflammatory bowel disease (Crohn's disease and ulcerative colitis), lupus, asthma, cancers, and several types of arthritis. Review side effects and adverse events before using this medication.
Multimedia: Slideshows, Images & Quizzes
Rosacea, Acne, Shingles: Common Adult Skin Diseases
Learn to spot and treat skin conditions commonly found in adults such as acne, eczema, shingles, psoriasis, rosacea, hives, cold...
Rheumatoid Arthritis (RA) Symptoms & Treatment
What is rheumatoid arthritis (RA)? Learn about juvenile rheumatoid arthritis. Discover rheumatoid arthritis (RA) symptoms,...
Ulcerative Colitis Symptoms, Causes, and Treatment
Ulcerative Colitis is a form of inflammatory bowel disease and is slightly different than Crohn's disease. Your diet can impact...
Inflammatory Bowel Disease (IBD) Causes, Symptoms, Treatment
What is inflammatory bowel disease? IBD can include Crohn's disease and ulcerative colitis. Learn more about testing, treatments,...
Crohn's Disease: Symptoms, Causes, Diet
What is Crohn's disease? Get more information on this digestive disorder and how Crohn's can affect your diet. Learn more about...
Osteoarthritis (OA): Treatment, Symptoms, Diagnosis
Osteoarthritis (OA) is a degenerative joint disease affecting both cartilage and bone. Joints most often affected by...
Eczema (Atopic Dermatitis) Causes, Symptoms, Treatment
Eczema (Atopic Dermatitis) is a common allergic skin condition. Get the latest information on causes of eczema and skin rash...
Acne: Causes, Solutions and Treatments for Adults
Adult acne causes include hormones, medications, makeup, and other things. Adult acne is treated with medications, products, face...
Rheumatoid Arthritis (RA) Exercises Slideshow: Joint-Friendly Fitness Routines
Regular exercise boosts fitness and helps reverse joint stiffness for people with rheumatoid arthritis (RA). Our experts offer...
Exercises for Knee Osteoarthritis and Joint Pain
Learn about osteoarthritis and exercises that relieve knee osteoarthritis pain, stiffness and strengthen the knee joint and...
What Is Asthma? Symptoms, Causes, and Treatments
What is asthma? Learn information about asthma, a chronic disease of the bronchiole tubes. Discover information about asthma...
Tips for Healthy Joints: Exercise, Nutrition, & More in Pictures
Dealing with joint pain and arthritis? Learn why weight matters--and why NOT to stretch before exercise. See these solutions for...
Acne 101: Types, Best Treatments, Medication, Cystic Acne
What is the best treatment for acne vulgaris? Can food choices influence acne? How can you get rid of blackheads? Learn why it's...
Bronchitis Symptoms and Treatments
Is bronchitis contagious? Learn about bronchitis, an inflammation of the lining of the lungs. Bronchitis can be aggravated from...
Asthma Attacks: Triggers, Symptoms, and Treatment
Asthma symptoms include coughing, wheezing, headache, fatigue, dark circles under the eyes, trouble sleeping, and loss of...
Atopic Eczema (Atopic Dermatitis) Quiz: Test Your Skin Disorders IQ
Does dry, itchy, flaky, scaly, red, inflamed skin sound familiar to you? Take the Atopic Eczema (Atopic Dermatitis) Quiz to learn...
Acne (Pimples) Quiz: Test Your Medical IQ
Acne is the most common skin disorder in the world. If you suffer from acne, you are not alone and many treatment options are...
Ulcerative Colitis Quiz: Diet, Symptoms & Treatment
What is ulcerative colitis and what risks are associated with suffering over the long term? Take this Ulcerative Colitis Quiz to...
Asthma Quiz: Test Your Medical IQ
Asthma is a chronic disease of the airways of the lungs, which can be managed with proper treatment. Triggered by two main...
What happens within the body when a person develops bronchitis? Take this quick quiz to learn the causes, symptoms, treatments,...
Crohn's Disease Quiz
What causes Crohn's disease? What are the symptoms of Crohn's disease? How is Crohn's treated? Take this quiz to get the facts...
Rheumatoid Arthritis Quiz: What is Rheumatoid Arthritis?
How is rheumatoid arthritis different from other forms of arthritis, such as osteoarthritis and gout? Take the Rheumatoid...
What is Asthma? Asthma Myths Debunked
There is currently no cure for asthma, and no specific, single cause for asthma has been identified. Take this quiz on asthma...
Skin Health: 15 Tips for Clear Skin
Acne, pimples, zits and blemishes often appear on the face, back, chest, neck, and shoulders where skin has the most amount of...
Picture of Allergic Contact Dermatitis
A red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign....
Picture of Erythematous Deep Acne Scars
Acne scarring is a common sequel of severe inflammatory or cystic acne. It can present in a mild or cosmetically disfiguring...
Picture of Acne Vulgaris Nodulocystic
Inflammatory nodules, cysts, and pustules (left). See a picture of Acne Vulgaris Nodulocystic and learn more about the health...
Picture of Atopic Dermatitis
This condition is the most common of all pediatric dermatoses. See a picture of Atopic Dermatitis and learn more about the...
Picture of Cystic Acne
Cystic acne is a type of abscess that is formed when oil ducts become clogged and infected. See a picture of Cystic Acne and...
Picture of Bronchitis
Acute bronchitis usually comes on quickly and gets better after several weeks. See a picture of Acute Bronchitis and learn more...
Picture of Boil
A boil, also referred to as a skin abscess, is a localized infection deep in the skin. See a picture of a Boil and learn more...
How to Get Rid of Acne: Skin Care Tips
Want to know how to get rid of blackheads? Discover tips on clogged pores, sunscreen SPF and how to remove makeup for different...
Picture of Osteoarthritis
Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more...
Picture of Allergic Contact Dermatitis (Tattoo)
Contact allergy to temporary tattoos has become an increasingly common phenomenon. See a picture of Allergic Contact Dermatitis...
Picture of Acne
Exactly what causes acne? Acne develops when cells and natural oils begin to block up tiny hair follicles in the skin. See a...
Picture of Atopic Dermatitis or Eczema
Eczema is a skin condition caused by inflammation. See a picture of Atopic Dermatitis or Eczema and learn more about the health...
Acne Care Pictures: Skin Care Dos and Don'ts
Explore quick acne cover-ups, dos and don'ts. See solutions on how to best handle pesky pimples and remedies to avoid.
Worst Smog Cities in Pictures: Air Pollution, Ozone, and Asthma
Learn the worst smog cities in America. See the 10 cities with the most polluted, unclean and smoggy air.
Exercises for Osteoarthritis -- Yoga, Swimming, & More
Check out this slideshow on Active Living From Day to Night with Osteoarthritis. Even with arthritis you can keep your active...
Related Disease Conditions
Boils (Skin Abscesses)
A boil is a skin abscess, a collection of pus localized deep in the skin. There are several different types of boils. Among them are the following: furuncle or carbuncle, cystic acne, hidradenitis suppurativa, and pilonidal cyst.
Colitis refers to inflammation of the inner lining of the colon. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis, including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, ulcerative colitis, infectious colitis like C. difficile, or microscopic colitis). Treatment depends on the cause of the colitis.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the base of hair follicles. This inflammation, depending on its location, can take the form of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Eczema is a general term for many types dermatitis (skin inflammation). Atopic dermatitis is the most common of the many types of eczema. Other types of eczema include: contact eczema, allergic contact eczema, seborrheic eczema, nummular eczema, stasis dermatitis, and dyshidrotic eczema.
Ulcerative Colitis Diet Plan
An ulcerative colitis diet plan can help a person with the disease avoid foods and drinks that trigger flares. There also are foods that can soothe ulcerative colitis symptoms during a flare. Types of ulcerative colitis plans include a high-calorie diet, a lactose-free diet, a low-fat diet, a low-fiber diet (low-residue diet), or a low-salt diet. Self-management of ulcerative colitis using healthy lifestyle habits and a nutrient rich diet can be effective in management of the disease. Learn what foods to avoid that aggravate, and what foods help symptoms of the disease and increase bowel inflammation.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The 16 characteristic early RA signs and symptoms include the following. Anemia Both sides of the body affected (symmetric) Depression Fatigue Fever Joint deformity Joint pain Joint redness Joint stiffness Joint swelling Joint tenderness Joint warmth Limping Loss of joint function Loss of joint range of motion Many joints affected (polyarthritis)
Arthritis (Joint Inflammation)
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout, and pseudogout.
Steroid Drug Withdrawal (Symptoms)
Corticosteroid drugs such as prednisone and prednisolone are commonly used to treat asthma, allergic reactions, RA, and IBD. Steroids such as these do have serious drawbacks such as steroid withdrawal symptoms such as: fatigue, weakness, decreased appetite, weight loss, nausea, vomiting, abdominal pain, and diarrhea. Speak with your health care provider prior to tapering off steroid medications.
Crohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Inner Ear Infection (Labyrinthitis)
Labyrinthitis is inflammation of the labyrinth (the part of the ear responsible for balance and hearing). Doctors do not know the exact cause of labyrinthitis; however, they often are associated viral infections of the inner ear. Symptoms of labyrinthitis are ear pain or earache, ear discharge, problems with balance and walking, ringing in the ears, dizziness, nausea, vomiting, and vertigo. Viral infections associated with labyrinthitis are contagious. Home remedies may help labyrinthitis symptoms and signs. Over-the-counter (OTC) and prescription medication may treat inner ear infections, labyrinthitis symptoms like vertigo and nausea, and help ear pain.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are options.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of cartilage in the joints. Also known as degenerative arthritis, osteoarthritis can be caused by aging, heredity, and injury from trauma or disease.
Asthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of breath. Causes of asthma include genetics, environmental factors, personal history of allergies, and other factors. Asthma is diagnosed by a physician based on a patient's family history and results from lung function tests and other exams. Inhaled corticosteroids (ICS) and long-acting bronchodilators (LABAs) are used in the treatment of asthma. Generally, the prognosis for a patient with asthma is good. Exposure to allergens found on farms may protect against asthma symptoms.
Inflammatory Bowel Disease (Intestinal Problems of IBD)
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Bronchitis (Acute) Contagoius Symptoms, Causes, Treatment, and Recovery Time
Bronchitis is inflammation of the airways in the lung. Acute bronchitis is is short in duration (10 to 20 days) in comparison with chronic bronchitis, which lasts for months to years. Causes of acute bronchitis include viruses and bacteria, which means it can be contagious. Acute bronchitis caused by environmental factors such as pollution or cigarette smoke is not contagious. Common symptoms for acute bronchitis include nasal congestion, cough, headache, sore throat, muscle aches, and fatigue. Acute bronchitis in children also my include runny nose, fever, and chest pain. Treatment for acute bronchitis are OTC pain relievers, cough suppressants (although not recommended in children), and rest. Infrequently antibiotics may be prescribed to treat acute bronchitis.
Second Source article from Government
Chronic Bronchitis (Symptoms, Causes, Treatment, Remedies)
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary, or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with anti-inflammatory medications.
Is Colitis Contagious?
Colitis is a term that us used to describe inflammation of the colon. The terms enteritis, proctitis, and inflammatory bowel disease (IBD) now include colitis. Colitis has many different causes. Some types of colitis are contagious and some are not contagious. Symptoms of colitis include diarrhea, abdominal discomfort, cramping, pain, and blood in the stools. Treatment for colitis depends on the cause and type of colitis.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered-dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC asthma drugs like Primatene Mist and Bronkaid.
Mixed Connective Tissue Disease (MCTD)
Connective tissue diseases are disorders featuring abnormalities involving the collagen and elastin. Connective tissue diseases that are strictly inheritable include Marfan syndrome and Ehlers-Danlos syndrome. The classic immune-related connective tissue diseases include systemic lupus erythematosus, rheumatoid arthritis, scleroderma, polymyositis, and dermatomyositis. Treatment is often directed at suppressing the inflammation present in the tissues by using anti-inflammatory and immunosuppressive medications.
Aseptic necrosis (avascular necrosis or osteonecrosis) develops when blood supply diminishes to an area of bone and causes bone death. Though aseptic necrosis may be painless, pain is often associated when using the degenerating bone. If caught early, aseptic necrosis may be treated by grafting new bone into the degenerating area. In later stages, joint replacement surgery may be required.
Are Boils Contagious?
A boil is a hair follicle that has been infected with bacteria. Boils can spread if a person's boil touches another person. Treatment typically involves draining the boil and using topical and/or oral antibiotics to eliminate the bacteria inside the boil.
Juvenile Rheumatoid Arthritis (JRA)
Juvenile rheumatoid arthritis (JRA) annually affects one child in every thousand. There are six types of JRA. Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Granulomatosis With Polyangiitis
Granulomatosis with polyangiitis is a condition that usually affects young or middle-aged adults, is an inflammation of the arteries supplying blood to the sinuses, lungs, and kidneys. Symptoms of granulomatosis with polyangiitis include bloody sputum, fatigue, weight loss, joint pain, sinusitis, shortness of breath, and fever. Granulomatosis with polyangiitis may be fatal within months without treatment. Treatment aims to stop inflammation with high doses of prednisone and cyclophosphamide.
Asthma in Children
Asthma in children manifests with symptoms such as coughing and wheezing. Rates of asthma in children are increasing. Asthma in children is usually diagnosed based on the description of symptoms. Lung function tests may also be used. A variety of medications are used for the treatment of childhood asthma.
Emphysema, Chronic Bronchitis, and Colds
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory infection such as pneumonia. Avoiding cigarette smoking, practice good hygeine, stay away from crowds, and alerting your healthcare provider if you have a sinus infection or cold or cough that becomes worse. Treatment options depend upon the severity of the emphysema, bronchitis, or cold combination.
Treatment & Diagnosis
Medications & Supplements
Rheumatoid Arthritis Resources
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
prednisone (Rx). Medscape. 2019