How long does it take for the steroids to work?

Hi, I was diagnosed with PMR last Tuesday following weeks of excrutiating pain in my left arm, my back and hips. I am 52 years old and am currently on sick leave as I struggle to get out of bed, dress myself and drive. I have started on 20mg prednisone and will see the consultant again in 4 weeks. So as this is the fourth day on steroids I was hoping for an improvement as so many people seem to report. My arm is worse and I feel little improvement in back pain and hips. Am I expecting results too soon?

Your thoughts would be very welcome.

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10 Replies

  • Hi Sandra. I can only speak from my own experience, in that after two weeks of horrible stiff and painful upper arms and neck, I was pain free after 36 hours of Prednisolone at 15mgs daily, so that was only two tablets. This is the classic...

  • Like Sandra I had a very fast response of 4hrs to 15mgs if Pred. To confirm a diagnosis they say that pain should be 70% improved in 7 days. You are already on a decent dose as the recommended dose is 10-15mgs, did you have the classic description of PMR, and has your GP tested you for other illnesses that can mimic PMR. Low Vit D levels can cause similar pains and your GP should test for this to rule it out. It doesn't sound like your getting much relief at all. I had PMR for 14 months before they gave me Pred to try, and still had an amazing response. Hope your pains settle soon. X

  • Hi, I'm new to this too but I was led to believe that pain/ discomfort is nearly always felt in BOTH arms, legs, both sides of neck, etc. You say you get pain in left arm................ do you get any pain in the other arm?

  • Thanks Angela, runng01 and David for your comments. I think my plan will be to ring the consultants secretary if I don't get a 70% improvement after 7 days. I still have tramadol and co-coda mol from my GP. Is the vitaminD deficiency tested by a blood test because that hasn't been mentioned. Also thank God my right arm has been OK no pain at all.

    All the best and thanks again


  • I had to wait a whole fifteen hours for relief! It does sound like it may be an incorrect diagnosis as you are not feeling better on steroids, there is usually a miraculous improvement quite quickly, also PMR tends to be bilateral pain in both shoulders and/or hips. You can have a blood test for vit D, your GP should OK it for you. You could of course have fibromyalgia which does not respond to steroids.

  • I too was diagnosed las Tuesday with pmr, the doctor told me that a quick response to pred would confirm the diagnosis. Like the others have I responded in a matter of hours of 20mg of steroids & that awful pain subsided, I still have a little residual stiffness & get tired easily but so much better without the pain. Like you have been advised I'd give the doctor a call & tell them how you feel your responding & see what they say, they may want to investigate further. Best of luck to you......we all understand the pain & hope you turn a corner soon

  • Hi Sandra 123,

    It's certainly worthwhile getting your Vit D levels checked but as low Vit D goes hand in hand with auto immune disease correcting low levels isn't a panacea for joint pain. My Vit D and B12 levels were profoundly deficient, replacing them made no difference to my symptoms.

    You don't say what tests your Rheumy ran, whether it was just standard inflamatory markers ( ESR, CRP etc ) or whether they ran a full auto immune inflamatory screen ( ANCA, ANA, CK etc ).

    I think that some patients get bilateral pain with PMR and others don't, the condition appears to be very individual. Usually painkillers like Tramadol and Co codamol don't help the pain associated with PMR so that may be another clue.

    Everyone has given you good advice, I would phone your Rheumy's secretary and at least talk it over with them. There are a few auto immune conditions that can present with polymyalgic type symptoms. My presenting symptoms were very typical of PMR and I did have a response to steroids but 2 years on I remain without a diagnosis, although the field is narrowing! Good luck with it all.

    Best wishes


  • Your description does sound as if it is NOT the PMR we talk about here, one that responds well to a moderate dose of steroid. The criteria include a global 70% improvement in symptoms within 24-48 hours of starting a moderate (15-20mg/day) dose of corticosteroid. Other things will respond a bit to the pred but not in the same dramatic way as PMR.

    PMR is the name given to a set of symptoms that can be caused by a range of causes - this is a good description, a bit medical but the differential diagnosis section is good:

    PMR is usually similar on both sides but can be one-sided in the early stages - but it still would respond to pred. PMR as we mean is a diagnosis of exclusion - the other options have been eliminated and PMR is all that is left. However, late onset RA is very similar and can be seronegative. So can other arhtritises.

    Other than RA, my immediate suspicion would be myofascial pain syndrome which can be very similar to PMR but appear more one-sided. A sports physio or sports massage therapist would be a good person to ask and I would go to my Bowen therapist to see if she could help.

  • When I first started on pred I was really concerned that I did not get the miraculous reaction that others described and it took about four days for minor improvement and a week and a bit for me to feel properly human again... I have never been pain free (I also have PsA) but as long as I can move and perform basic daily tasks without crying I am happy enough.

  • I must admit I felt brilliant after to 3/4 days on my steroids, but 6 months down the line I am having more aches and pains, good luck

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