Confused about prednisolone dose

[panther50]

My mum who is 80 has recently had a diagnosis of PMR (she also has RA and osteoarthritis so its taken a while to reach this) . Up until now because the diagnosis wasn't PMR, her pain and symptoms had been managed with steroid injections, which wore off & needed repeating every 3 months. With the diagnosis of PMR the GP has just prescribed her 15mg prednisolone. She said she felt amazing the first day she took it and all her pain went, but next day was a bit disappointing because it didn't as much effect. She's been on them 5 days now-overall it sounds like there is a marked improvement in both movement and pain, but difficulty going upstairs is still there in the evenings (very difficult getting out of chair still in evening). How long should improvement take, should she give it 7-10 days before reviewing dose? I've read all symptoms go within 24-48 hours (which they did in first 24 hours)? & 70% respond quickly with all symptoms going, does that leave 30% who take a little longer?

[daveD]

LO panther. just a brief post till others post, just wonder if mum is trying to do to much with a lot of the pain gone we have to learn not to over do things,plus we have normal? age related aches&pains.I am thinking some of the more knowagble folk will be along to explain the ups&downs of this strange journey all the best to you both.Dave

[Celtic PMRGCAuk volunteer]

panther, the 70% you may have heard about refers to an expected 70% improvement in symptoms within a few days or even hours of taking a first dose of 15mg of Prednisolone. I was someone who experienced relief in the worst of my symptoms within a couple of hours of taking 40mg (I also had GCA which requires a higher dose).

From what you have written, it sounds as though your mother is experiencing a very good response to the steroids after just 5 days. It can take a lot longer to achieve a big improvement in the pain/stiffness involved when getting up and down from chairs and climbing stairs. That should gradually improve over time as the steroids get complete control over the inflammation,but the time involved can vary from person to person. Importantly, your mother should remain on the starting dose for at least 4-6 weeks and then, if she is still comfortable and blood test markers have improved (if they were found to be raised at diagnosis), a small reduction can be attempted. I hope she feels better soon.

[panther50 in reply to Celtic]

Thanks for your replies and clarifying the 70%. I think I wasn't very clear about the dose. I was wondering if the initial dose may need to be 20mg if she doesn't get continued improvement and symptoms persist. It's a bit hard to tell, as I think shes getting an improvement in the morning which seems to wear off by evening. From what you've both said it sounds like we just need to be patient. Her ESR result was over 40. CRP normal.

[Rjw2014]

Also from my experience if there is something else going on, in my case long standing back problems, these will not be solved by the pred. My rheumy blandly told me that after 30 years of looking after horses I must expect to have backache and to take paracetamol!

[panther50]

Thanks Rjw. Yes her initial diagnosis of RA and osteoarthritis weren't wrong. So these are still going on (osteo) & RA may not respond as well as Polymyalgia to prednisolone. It does explain why the Depo medrone injections that contain prednisolone worked last year and Kenalog didn't. Are injections considered worse for you than tablets?

[iforget in reply to panther50]

I have PsA as well as pmr and i have joint injections too....but they limit them to a Max of 3 per joint per year because of the effects they have on bones. They try where possible to give them even less frequently when on pred.

[PMRpro Ambassador in reply to panther50]

Iforget mentioned the joint cortisone injections and being limited - they are different from depomedrone as intramuscular injections. You need them every few weeks and I imagine most people aren't elated at the idea of having injections which can be painful so often compared to taking a little tablet. I also imagine depomedrone injections cost more than plain white tablets! PMR can go on for years so those are considerations.