Pain is bearable

[Reneej]

I'm down to 8.5 mg of prednisone after starting at 20 in April. I had gotten down to 7 but due to traveling and my mistake in taking a 1 mg pill instead of a 5 mg, I had a small flare and went back to 10mg. My pain level is minimal, mostly wrist pain. I can still play tennis! I went to my rheumy for my follow up appt and when he asked how I felt, I told him good, except for the wrist pain. He said he wants me to increase back up to 10 so I have no pain. I don't really want to because this pain is absolutely tolerable. BTW, my CRP was down to .11 form 2.0, and my SED rate was always normal. My question is, do I up the prednisone like the dr said, or stay where I'm at. I was actually going to lower it to 8 starting next week! Am I inviting a flare to start?

Thanks for your suggestions!

[HeronNS]

You'll get good advice from the experienced experts here, but my feeling is if you find the pain tolerable and it isn't interfering at all with your activities, why not stay at your current level for a few more days and see how it goes? If the pain starts to increase, and if it does it will likely happen soon but gradually, then you should promptly go up as your doctor says. If it stabilizes, then you may be at an optimum dose that you should stay at for a while longer before attempting a (very small) taper down using the wonderful dead slow and nearly stop method. I've based that on my own experience when I attempted to drop (I didn't know about dead slow at the time) from 10 to 9. I went up to 10 again after increasing pain at 9 over a period of about 10 days. I was starting to have trouble rising from chairs, etc, in other words the beginning of a flare. After I felt good at 10 and no changes for a couple of weeks I started tapering again using dead slow method. As always, you know your body best. Trust your instincts. Good luck!

[Reneej in reply to HeronNS]

Thanks for such a quick response!

[PMRpro Ambassador]

Did you really have no pain at 10? It's difficult - the normal assumption by most patients is that you are left with some pain, many doctors think that you should be pain-free on pred but it really doesn't follow. On the other hand - if I'm going to have a flare as I reduce it ALWAYS starts in my wrists. Some doctors would suggest that is osteoarthritis. So some of your own assessment needs to be looking at how that flare started with your missing 5mg dose. If it were me I might try 9mg again and see what difference that makes - but in fairness I wouldn't reduce to 8mg yet.

[Reneej in reply to PMRpro]

I can't remember if I was pain free at 10mg! When I missed the 5mg dose it definitely started in my wrists. I think I will go to 9 and see if there's a difference. If there's no difference in pain level, I'll go to 8.5 for 2 weeks and then to 8. Thanks for the reply!

[PMRpro Ambassador in reply to Reneej]

It is actually very handy to keep a diary - dose reduction/increase and changes in pain/stiffness and so on. Then you can look back and know "this happened when I did this before, it took some time but it went away eventually" or "...it got worse"

[Reneej in reply to PMRpro]

Will try that!

[HeronNS in reply to PMRpro]

Good idea!

[Turra_Loon]

I sympathise with Reneej confusing the 1mg prednisolone pill with the 5mg pill. I have done so myself. The two are just far too similar in size and identical in colour. Mistakes are far too easy and perhaps inevitable. It can not be difficult or expensive for manufacturers to charge the shape of colour of one of them.

I posted about this once before but no one felt able to support me.

[PMRpro Ambassador in reply to Turra_Loon]

Colour is a problem though - patients often develop allergic reactions to the colours. In terms of shape or size - if you go online and look at how many different drugs there are you would see that having every single tablet totally different would be very difficult. Then each manufacturer has their set of machinery that cost a lot to set up - and every country has different companies.

[Turra_Loon in reply to PMRpro]

Colour can not be such a big problem. There are many colours already used for various pills and that would soon stop if it was causing any harm. As for shape, it would not be necessary to have “every single tablet totally different”; only where there is confusion and possible danger as with Prednisolone 5mg and 1mg. With so many manufacturers as you describe surely one of them could steal a march on their rivals when setting up new plant. It's how business operates and makes advancement through competition and innovation.

I am disappointed that PMRpro's comments were negative and unsupportive. Any manufacturer looking at this site might conclude that there is no demand for any change.

[HeronNS in reply to Turra_Loon]

Where I live the two prednisone sizes, 5 mg and 1 mg are both white, but so different in size I cannot imagine anyone confusing them. In fact the 1 mg is so small I don't know if it will be possible to cut one in two when I get to that stage. It is probably more expensive to make a lozenge shape, which is too bad because I think that shape could be more easily divided.

[Reneej]

I agree! I certainly won't make that mistake again!