Temporary increase

[suethompson99t]

Just a quick question - I asked a few days ago about going up from 5mg to 10 mg for a short time and then going straight back to 5mg. PMRpro on here said that would be ok for a day or two, as did my Rheumatologist - 1 or 2 days will be fine he said.

Mentioned the same to my GP yesterday to see what he thought and he said 1 or 2 weeks would be ok - just wondering what people here thing about that length of increase? Would I need a slower decrease to get back to 5mg?

I am generally ok with 5mg - just slight aches in the shoulders and upper back but nothing I can't handle. But recently had some treatment which causes reactive arthritis and I can feel the aches getting worse, so I'm tempted to try an increase to see if it sorts this out, but not sure if 2 days increase would be long enough to tell?

Any thoughts welcome.

[Celtic PMRGCAuk volunteer]

Sue, as you say your aches are getting worse, I feel it's very much a case of firstly getting back to 10, (perhaps even 7.5mg might be sufficient), and then waiting to see whether your pain lessens. Only then will you really be at a point of questioning how long you need to remain at that dose. Everyone is different in the way their body responds to a flare and to an increase in dose. When I increased back to 10mg as the result of a flare, I spent 2 weeks at 10mg, then a further 2 weeks at 7.5mg, returning to 5mgs and remaining there for many months before continuing in tiny half mg reductions, tapering slowly to each new dose over about 7 weeks. I was lucky to be guided by a rheumy with vast experience as to the wiles of PMR and steroids.

[suethompson99t in reply to Celtic]

Thank you, I may try that.

[PMRpro Ambassador]

i would think that 2 or 3 days would be enough to see if it is going to make any difference - then you can make the decision whether to stay there longer. You have to try to find out I suppose.

Technically your GP is probably right - I was started on 2 weeks of 15mg, 2 weeks 10mg, 2 weeks 5mg. The 5mg drops each time posed me no problem at all at the time. Later, after years on pred, a smaller change in dose if far more problematic. No idea why - except the long time I have been on pred. Everyone is different in how it affects them and I think Celtic's approach might be better.

Would more pred usually help this reactive arthritis? I "flared" last week while I had a disgusting cold - I was in the process of reducing from 8 to 7 so stopped the reduction but the 1mg didn't make much difference. Now the cold has cleared up, so have the pains. And I'm on the way back to 7mg.

[suethompson99t in reply to PMRpro]

You're right I will have to try it and see. I have been on Pred for approx 6 months now, started high and did the 2 weekly decreases as yourself. The high dose definitely help my initial occurrence of reactive arthritis and 5 mg has managed it up to now but every treatment I have has stronger side effects, which is why I'm tempted to try a higher dose now. Maybe going back down via 7.5mg is a better idea. I just don't want to end up taking months to get back down.

Thanks for the advice, much appreciated, as always.

[PMRpro Ambassador in reply to suethompson99t]

I had to go back from 5mg to 15mg for a flare last February. The local hospital doctor (not a rheumy but someone with a special interest in GCA, my GP is rheumy trained) said just get back to 8mg "by the summer". which I managed just. But I really don't care what dose I'm on - I just take the lowest dose where I feel well. That is my basic criterion - after 5 years of unmanaged PMR and 12 years altogether perhaps I have a different view to most people.

[Lafontainepam1 in reply to PMRpro]

Yes I too have noticed the longer you are on Prednisone the more dramatic going up and down is. The last time I tried 1/2 milligram degrease, two people in my family died. I wonder if I'll ever get lower than 7 again!!