Reduce prednisone

[Solna]

I am 58 years old and has been diagnosed with PMR.

I received 20mg starting dose and take this dose now for 4 weeks. When you began reducing prednisone, were you then completely symptom-free from pain and stiffness?

Or is it the blood tests that determine if you can start reducing the dose?

Or can you start to reduce with a little stiffness / pain?

I feel much better, but is still a bit stiff in the morning.

[PMRpro Ambassador]

No, it is rare for a patient to be totally pain free, especially at the start. The doctors should be looking for a 70% overall improvement in the symptoms within a week or so in response to 15-20mg pred as sonfirmation of the suspicion of PMR - it may be better and may improve later. The response may improve with time - and if you do have raised markers they should be as low as they will go before trying to reduce.

If you take the pred very early, when you first wake, and then settle down for another couple of hours the pred will have started to work and you will be less stiff,

This helps too

butyoudontlooksick.com/arti...

[Solna in reply to PMRpro]

Thanks for the reply!

How many weeks tend to be typically the starting dose?

The markers, what level should they be on to start the reduction of pred? Is the ESR and CRP?

[PMRpro Ambassador in reply to Solna]

Six weeks is typical for the starting dose and for the first reduced level - but it should be until the symptoms aren't improving any more and the markers (yes, ESR and CRP) have stopped falling any further - that is the point there is no residual inflammation present. However - at all times, symptoms are trumps. Your ESR/CRP may look OK but you have symptoms - there is almost always a lag period before they rise again or in falling. The normal range is said these days to be up to about 20 (they used to accept higher in older patients). But my normal ESR is 4 - but I also never got a high level during PMR, even when I could barely move. I did get annoyed at the rheumy insisting on checking them - I minded less in the UK as I didn't have to pay for the blood test, I do here!

[piglette]

Hallo Solna, I have never been totally pain free unfortunately, although some lucky people are. Have you talked to your GP about your reduction plan? I started on 20mg and my rheumy insisted I reduce to 15mg after three weeks, my ESR was in the 90s and my CRP in the 30s at that point but had reduced from the initial figures of ESR 127 and CRP 123. In hindsight this was a total disaster, the rheumy seemed hell bent on me reducing as soon as possible, which quite a lot of doctors appear to, as they seem so worried about the pred side effects. Let your body dictate to you. If you feel OK to start reducing that is fine but take it slowly. Not more than ten per cent at any one time. Good luck.