Increasing preds if knowingly going to have a stress day

[notnice]

Hi there

I have read that some of you have increased your preds if you know you are going to have a stressful day, can anyone explain to me how this works, how many do you increase by and do you have to decrease slowly again back to the amount you were on before the increase? Hope you can help.

[PMRpro Ambassador]

Stress and PMR don't mix well - many people think it was stress that finally triggered their PMR to develop. The normal response of our body to stress is to produce a peak of more cortisol, the body's natural corticosteroid, which allows us to cope with the stressful period. When we are on pred our body may be less able to produce these peaks of natural cortisol and it has been recommended for many years that a slightly higher dose of pred may be needed for major or longer lasting low level stress - like an operation, an infection, accident, stressful activity such as travel.

Many people have discovered that these stressful activities can apparently trigger a flare in the PMR symptoms, for a short time the current dose of pred isn't enough to manage the symptoms and they don't feel well, some may be quite disabled again. Some who have realised this know where taking an extra couple of mg for a day or two should avoid this problem in the future. Many of us have discussed it with our doctors and for most of us our doctors are helpful.

No, if you are having a temporary flare because of a short-lived problem you can take a slightly higher dose for a few days and then usually go back to the previous dose that worked well for you under normal conditions. The body shouldn't have got too used to a higher dose in a couple of days and it shouldn't have been much higher anyway. Anyone who is very sensitive to the change in dose may have to step back down - maybe 1/2mg every day or couple of days but it doesn't need to be as slow as is usually recommended. Part of that is also to identify the right dose for you and you knew what that was until the stress cropped up.

[notnice in reply to PMRpro]

Thank you very much for that it is very helpful.

[Trenny]

I am on 8.5 mg daily and have a temporal headache. I take the pred. at 9 am. It is now 9 pm. Should I try increasing by 0.5mg for a few days, I wonder? Or 1mg? The cause may be stress.

[PMRpro Ambassador in reply to Trenny]

Do check with your doctor if you have any GCA symptoms - let them keep an eye on it.

[Celtic PMRGCAuk volunteer]

Trenny, if the temporal headache is definitely due to GCA inflammation, whether or not caused by stress, then I think you would be wise to increase by more than just 0.5mg, perhaps trying 10mg for a few days. Do ask for repeat blood tests though.