Reduction of predsisone

[smiley67]

Am down to 7.5mgs and is it normal to have pain ? It will ease up in the late afternoon. The pain is like when this all started but not as bad as yet. It' has been 2 days snice I started the lowering of predsisone. If pain is to be expected how long will it last that I will know it's normal ? I started at 15 mgs 11. Weeks ago. For PMR

[PMRpro Ambassador]

To get from 15mg to 7.5mg in 11 weeks is very fast - I would say far too fast. The recommendations are 6 weeks at 15mg, 6 weeks at 12.5mg. One group recommends remaining at 10mg for a year - and find that reduces the rate of flare to 1 patient in 5 compared to the more usual suggested reductions where you would remain at 10mg for about 6 weeks before reducing 1mg at a time after that where the flare rate is 3 patients in 5. It is very difficult to reduce at more than 1mg at a time below 10mg anyway - and you cannot reduce if there is still inflammation present, the inflammation will get worse and the symptoms will come back. Pred has not cured the PMR - it is used to manage the symptoms until the underlying disorder goes into remission. In some lucky patients that happens in a couple of years, in quite a few it can take much longer than that.

In untreated less severe PMR the pain often eases in the afternoon anyway - what you describe sounds like a flare. However, if it is only steroid withdrawal pain you should find the pain and stiffness will improve over the next couple of weeks or so. If it continues to get worse it is more likely to be a flare.

You can do 2 things to help minimise these problems when reducing. One is to clear the decks and make sure you rest as much as possible during the first week after a reduction and don't do anything you don't have to. The other is to make each step as small as possible - never more than 1mg and if that still seems too much spread the reduction over a couple of weeks (or even more). I need 6 weeks to get from every day at one dose to every day at a dose 1mg less. I can't do it any other way - and I am not alone. A specialist I know of has been trying this form of reduction - his patients are succeeding where they haven't previously much to his surprise. It's not a surprise to us.

[smiley67 in reply to PMRpro]

Thanks This advice is very interesting. I will see how am feeling and go from there. Am still in pain and I went back to 10 mgs today. My Dr said to try 10 one day and 7.5 the next.

[PMRpro Ambassador in reply to smiley67]

From 10mg you shouldn't be trying to reduce by more than 1mg at a time - even alternating 10/7.5 is pushing it if you are getting to a borderline dose for your PMR as it is at the time.

Some thing we have found to work well, and a specialist is also trying as I mentioned, is to take the new dose on one day and then take the old dose for 6 days, new dose for one day, old dose for 5 days, new dose for one day, old dose for 4 days - and so on down to alternating days of old and new. Then old dose one day, new dose for 2 days, old dose for one day, new dose for 2 days - increasing the no of days at the new dose by one each time. At 6 days of new, one day of old - you can drop the old dose altogether. You have arrived at your new dose.

[smiley67]

Thanks for advice. I tried to get 1 mgs of pred but Dr would not give me it only 2 1/2 mgs which I find hard to break and still not 1 mg. I went back to 10mgs on my own doing as the pain was getting worse and I had a hard time getting up the steps. the pain is not getting better was down to 7.5 mgs only 3 days and so much pain this can't be right for a step down on dose. even on 10 I have had pain off and on. I don't fell they know how to deal with pmr here. I only have one reumey where I live and they say she is the best around here. To wait a couple of weeks to see if this pain is from withdrawal is way to painful for me just 3 days and am ready to cry. I want to go to a lower dose of Pred and have no pain at all and know it was the right dose for me.