I am down to 2mg of Pred.This week end had a flare up. Should I go back up to 3mg or more. Any suggestions. Rheumie suggested reducing 1mg

[Falkers]

per month I am due to see him in 2 weeks time.

[PMRpro Ambassador]

Many doctors like to hit a flare hard and say a week or so of 5mg more than the dose the flare hit at and then back to the dose you were OK at.

It may be reducing the pred at that rate that has caused the pain, rather than a flare. A reduction should never be more than 10% of the current dose - so at 5mg that is 1/2mg. 1mg at a dose of 3mg is 33%!

I remember Sambucca dropped from 3mg to 2mg and wondered why she had problems - until the percentage was pointed out! She went back to 3mg, and then used a totally different idea to reduce and never had a problem again. It is very similar to my reduction scheme:

My reductions are VERY slow. I use the following pattern to reduce each 1mg:

1 day new dose, 6 days old dose

1 day new dose, 5 days old dose

1 day new dose, 4 days old dose

1 day new dose, 3 days old dose

1 day new dose, 2 days old dose

1 day new dose, 1 day old dose

1 day old dose, 2 days new dose

1 day old dose, 3 days new dose

1 day old dose, 4 days new dose

1 day old dose, 5 days new dose

1 day old dose, 6 days new dose

By that stage if I feel OK I feel safe to go all new dose. I suppose you might be OK starting and stopping at "1 day new, 4 days old" but I was terribly sensitive to steroid withdrawal pain so I err on the safe side. Once you get to the "everyday new dose" - if you feel OK you can start on the next reduction, no real need to spend a month at the new dose.

This avoids steroid withdrawal pain - which is so similar to PMR pain that you often can't tell which is which and some of us suspect that many flares are NOT the PMR returning but problems with steroid withdrawal. Using a scheme like this also means you can stop immediately if you have any problems - you might be fine at one day old dose, 2 days new (lower) dose but not at a 3 day gap - but you have dropped your dose a lot and that is the idea. It also isn't as slow as you would think - you can reduce at a rate of about 1mg/month on a continual basis.

Hope this helps - you could try going back to 3mg for a couple of days and if the pain goes you will know it is steroid withdrawal. A consultant in the north of England is trying a similar reduction plan (the one Sambucca used) and is finding, as we have, that it works well for everyone.

[Falkers]

Thank you very much, I will try this and let you know how I get on.

[Annodomini]

I had been reducing at the gradual rate and was down to 1.5mg of pred, when I had a really miserable weekend with burning pains in my upper arms which I correctly diagnosed as a flare. The GP noted a rise in the inflammatory markers and put me back to 5mg. I will have another blood test after Easter and take it from there.

[Falkers in reply to Annodomini]

Thank you, I will see how I go on increase back to 3mg and if no improvement, will ask for a blood test.