GCA - tapering Pred?

[amieangel]

In May 2015 I came off my cortisone treatment after having had PMR and GCA for 2 years and 7 months. CRP and ESR immediately began to rise. Stiffness, sustained dry cough, temple tensions and jaw pain indicated continued inflammation, but I couldn't bring myself to accept this.

In January a new PET-CT showed inflammation in the whole aorta and outgoing branches. I previously had a dilation of the ascending aorta and had now also developed a new aneurysm in the abdominal aorta (3 cm wide). I began taking 60 mg Prednisolone in January and am now (15/5) on 30 mg. A new PET-CT has shown that all the inflammation in the aorta is gone.

My rheumatologist recommends that I lower the dosage by 5 mg every 14 days down to 20 mg and then by 2,5 mg at a time. To me this reduction seems a litte too fast. I used the very slow method the last time (one day old, six days new... etc.) At what dosage would it be appropriate to adopt this method?

My inflammation markers are now perfect and, other than some problems sleeping, I have no symptoms of either the disease nor the treatment.

[DorsetLady PMRGCAuk volunteer]

Hi,

Sorry to hear about your recurring problem.

My drops from 60mg were at 5mg every month, blood tests permitting until I reached 20mg, when I changed to 2.5mg until 15mg reached (still monthly). Then to 13 mg, and from then on by only 1mg a month until I got to 7mg. Then I started a slow reduction plan and dropped by 0.5mg only each time.

Once you get to about 7mg you need to be careful about your adrenal glands kicking in again.

As your pains and stiffness returned so quickly after you've finished your Pred last time around, I think you need to be very aware this time ensuring you keep the inflammation under control at all times.

Good luck.