Quick reduction of Pred

[Soon70]

I have upped from 7.5 mg to 15mg of Prednisolone (as advised by my GP) for what was thought to be a 'flare up' of PMR. After 8 days my symptoms have actually worsened so indicates the pain I am having in my thigh is not related to PMR. I therefore would like to reduce back to 7.5 as soon as possible. Bearing in mind the very short time I have been on 15mg, I would be grateful if anyone could advise as to how quickly I can achieve this. Thanks in advance.

[PMRpro Ambassador]

Pretty much as quickly as you like - maybe a day or two at 12.5 and 10 on the way down? Go by how you feel. It isn't as if you are aiming to zero, you are going back to the "physiological dose", the amount (-ish) that the body makes anyway.

What is the thigh pain like? Is it tenderness on the outer aspect of the thigh? Is there pain into the groin? Is it worse when/after climbing stairs? Any of that might suggest trochanteric bursitis, commonly found alongside PMR. It does best with local cortisone injections, it may take a couple a couple of months apart to get rid of it totally.

Or is it more like sciatica? Which can stem from myofascial pain syndrome in the lower back that causes referred pain into the thigh. Again, cortisone injections do the job quite well. Also found alongside PMR.

[Soon70 in reply to PMRpro]

Thank you so much for your quick reply. I'll reduce as you advise. My symptoms seems to be those you describe as trochanteric bursitis, I'll follow up with my GP.

[Daisyharper]

I have has PMR since last Spetember, been reducing pred now on 9mg, although this last week My hands have started aching again in the morning, lifting, opening doors ect is difficult, also had some sort of muscle spasm in my shoulder, which was treated by ultrastound at a private Physio, slowly getting better, wondering if I should go back to my GP and up the steroids again, I have my 60th coming up next month and want to feel well, your comments are welcome.

[PMRpro Ambassador in reply to Daisyharper]

To be at under 10mg in 6 months is a very fast reduction - a couple of reviews on PMR published in the last year or so by top UK PMR experts recommend sticking at 10mg for a year before trying any further reduction. Doing so, they find, leads to a relapse/flare rate of 1 in 5 instead of 3 in 5 which is more common with other reduction schemes.

What you describe is a typical beginning for a PMR flare due to the dose being too low and I would say you need to go back to at least 10mg as your maintenance dose for now, maybe with a few days of higher to get the returned inflammation under control.

If your GP is difficult about it show him this paper:

rcpe.ac.uk/sites/default/fi...

which is available to download free - this includes the reduction scheme the Bristol rheumatology department recommend. Kirwan is retired now but still involved in research.

[Daisyharper]

Thanks for quick reply PMR pro, I will follow your advice.