Pred for pmr and gca

[Soosie56]

I have now been diagnosed with both pmr and gca. Consultant has put me on 40mg pred for one week, then week on 30 then four weeks on 20mg. I will then have another appt with the consultant. Is this usual dosage? Thank you.

[PMRpro Ambassador]

I imagine it is probably what that consultant uses but it is a rather faster reduction than I am used to seeing. The BSR recommendations are for 4 weeks at 40mg

"Suggested tapering regimen

- 40-60 mg prednisolone (not <0.75 mg/kg) continued for 4 weeks (until resolution of symptoms and laboratory abnormalities).

- Then dose is reduced by 10 mg every 2 weeks to 20 mg."

The whole thing can be read here:

pmr-gca-northeast.org.uk/as...

A paper written for guidance in management of PMR and GCA by a group of rheumatologists in Bristol, and probably easier to read,

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

recommends the use of higher doses for longer:

"• 60 mg daily for four weeks, or until remission induction, then

• 50 mg daily for four weeks, then

• 40 mg daily for four weeks, then

• 30 mg daily for four weeks, then

• 20 mg daily for four weeks

The risk with the speed your doctor has suggested is of a flare if the inflammation is not fully under control - hence the longer periods others use for the starting dose and the emphasis on control of symptoms before reduction in both these recommendations.

I would say be very vigilant when you do reduce and if any symptoms are remaining at the end of the 4 weeks at 30mg or if any recur at any point go straight back to your doctor and ask for further advice.

[Soosie56 in reply to PMRpro]

Thank you again. I though it was an unusual dosage - only a week on 40mg then only a week on 30mg and then back to 20 mg ( which I had been on for about 12 days for pmr). I just wonder how long I should have the symptoms for. Concerned of course for my eyesight.

[PMRpro Ambassador in reply to Soosie56]

The GCA symptoms you mean? They should start to fade quite quickly on the 40mg and if they haven't gone at the end of the week then most doctors would say not to reduce until they had. 40mg is also the bottom end of the range for GCA - I take it you didn't have any visual problems as symptoms since that usually triggers a higher starting dose to be more sure of avoiding loss of vision.

If you have any problems over the weekend I wouldn't hesitate in going to A&E - if the symptoms get worse or even stay the same and don't improve at all. That to me would be an indication it wasn't high enough.

[Soosie56 in reply to PMRpro]

Thank you for your advice again. You don't know how much you all help - I am ok most of the time but panic strikes! So supportive thank you and informative.

[Celtic PMRGCAuk volunteer]

Soosie, we can all be a little different both in the way we present with our symptoms and to the treatment itself. So when you ask "is this usual dosage?", it might be for some but not for others. The main aim to to get each patient to the lowest dose that controls the inflammation and to avoid the potential side effects at these high doses.

In my case when diagnosed with both PMR and GCA, I was prescribed a 40mg starting dose and advised to reduce to 30mg after two weeks, with the added mention that 15mg usually contains it. My rheumy also gave me a helpline number to ring if my head pain returned. My ESR and CRP blood tests were repeated showing a great improvement so I was then advised to reduce from 30 to 20 after one more week. One week later I was able to reduce from 20 to 15 following which the reductions were slowed and in smaller decrements.

All my GCA symptoms resolved within hours of my first steroid dose, apart from the blurred vision which remained with me to a certain extent down through the doses, but I was assured by my rheumy that this was a side effect of the steroids, rather than being GCA-related. So it all depends on how a particular patient's inflammation responds to the steroids/resolution of symptoms. Importantly, as you are someone who had raised markers at diagnosis, your blood tests should be repeated before each reduction to ensure that the inflammation is under control at each subsequent dose before committing to a further reduction. I hope you will soon start to feel much better.

[Soosie56 in reply to Celtic]

Again, such sensible advice thank you. This is the best place for sharing and helping. Thank you so much.