Pred reduction

[David_H]

Hi, i'm currently on my 4th week on 9mg Pred (previously 5 weeks on 15mg, three weeks on 12mg and three weeks on 10mg) and notice my neck pain has improved but arm pain increased from hardly any when first diagnosed. Does it tend to work like this (moving aroung the body) and would I be better off 'riding it out' on 9mg and see how it goes or go back to 10mg (think I'd rather not go back if I can help it)? My GP suggested a total of 5 weeks on 9mg then reduce to 8mg. Thanks

[PMRpro Ambassador]

No, when pain moves around the body it is sometimes an indication that it is another inflammatory arthritis.

However, the reduction your GP has you on is extremely fast and if the inflammation is not fully under control any reduction will be unsuccessful. You are also not aiming relentlessly for zero - you are looking for the best result to start with and then you reduce the dose very slowly to find the lowest dose that achieves that result.

Show this paper to your GP for his consideration:

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

They take 3 months to get from the starting 15mg dose to 10mg where they keep the patient for a year before attempting to reduce further. It achieves a flare rate of 1 in 5 rather than 3 in 5.

[SandraMarric]

Hi Dave, I think that I am in a similar situation to you but not quite as far along the line. Diagnosed 9 weeks ago in March - 4 weeks 20mg (I am nearly 6 ft, so probably the correct initial dose), 4 weeks 15mg, and now 1 week into a 4 week (G.P. planned) 10mg, followed (or so the G.P. thought probable) by fortnightly reductions of 2mg or so thereafter if blood tests warrant it. Just like you, I find that, having initially most pain in a different area , the main stiffness has moved location to my shoulders, one in particular. Everyone on here says that my planned reduction is too fast and I agree. After a difficult day yesterday I have taken 12.5 mg pred today. It's not an easy decision for me because Ibuprofen at night makes the 10mg dose more or less ok. However I'm trying to do without the Ibuprofen on the advice of people on this site - and I am sure thay are correct. I think that I might pay to see a Consultant. Apparently there is an excellent clinic very close to where I live. Does anyone know if one can do this, get advice and then complete the treatment under a N.H.S. G.P?

Anyway, Dave, the very best of luck! Sandra

[David_H in reply to SandraMarric]

Hi sandra, if you're GP's any good he/ she should listen to advice you've been given on the forum with regard to tapering. You can always ask your GP to be referred to a Consultant (pretty standard practice I would have thought). If it's through the NHS you'll probably wait weeks but if you go private (about £100 for a consultaion only I'd guess) you'd get in in a few days or so.

[David_H in reply to SandraMarric]

Also, i've read (and experiencing) that it can be a struggle getting under the 10mg so I would think fortnightly reductions of any amount would be a no no. I will stick to my 9mg and see how it goes over next few days (which will be my 4th week at this dosage) and see if I want to up it back to 10mg

[PMRpro Ambassador in reply to SandraMarric]

Depends on your private consultant - nice ones will see you and then add you to their NHS list if they have one. If they don,t have one, obviously they can't. Where do you live? Maybe someone can suggest a good one.

The reduction steps should never be more than 10%of the current dose so by now you should be looking at 1mg drops rather than even 2.5mg and 5mg drops in PMR are just crazy - yes, I know that is how it works in other things, this isn't other things. As for 2mg steps from 10mg after 4 weeks there - it sounds as if your GP thinks PMR responds to and is cured by a relatively short course of pred. No, 2 YEARS is the short end of the story - 4 to 6 years is far more common.

At least persuade the GP to read this:

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

It is written to assist GPs in the diagnosis and management of PMR without having to send the patient to a hospital specilaist