Taking Pred at night??

[Roltuba]

I often read posts on this wonderful site and can readily identify with comments about not blaming PMR for all one’s aches and pains! However, could you give me some advice on whether or not to try taking my Prednisolone in the evening? I’d better say a bit about the context.

I’ve been on Prednisolone since my diagnosis of PMR in March 2015 and have brought the dose down to 4.5mg. I’m a fit and active 69 year old bloke (well I was until the PMR struck) and have become highly motivated to reduce my dose for 3 reasons. Prednisolone can increase eye pressures (I have quite serious Glaucoma) and also weaken tendons. The tendon matter may be controversial, but I’ve recently been told by my Orthopaedic Surgeon that my right shoulder is “a mess” (Massive Rotor Cuff Tears) and inoperable as he thought that Prednisolone may well have so weakened the tendons that they would tear like paper if he tried to join them. Also my recent Dexascan showed the bone density in my pelvis is significantly reduced for my age.

The first week on 4.5mg was fine, but in the last few days my morning stiffness has increased considerably and my left leg has become painful and weak. This is a new development. Generally the stiffness improves as the day wears on but the leg hasn’t kept up and has become painful during the night!

I found Kate Gilbert’s post about taking the pred at night and am aware that there may be good reasons for not taking it then – though my sleep (and my wife’s!) is already being disturbed by the pain in my leg. However, as I really don’t want to resort to increasing the dose I’m seriously considering taking the steroid before bed. The Rheumatologist I saw twice has discharged me, saying “keep up what you are doing.” I feel I know more than my GP now. Any comments would be gratefully received.

[PMRpro Ambassador]

I can't see any reason why not to try it and see if it helps you. But it doesn't matter how/when you take pred: if the autoimmune part of the PMR is still active you will need some pred and you won't get below the lowest dose that manages the inflammation. To be at 4.5mg after 18 months isn't bad!

I take a form of pred that automatically does the "2am optimum time of dose" - taking ordinary everyday white pred at 2am means the blood level is at its maximum at about 4am, in time to catch the morning dose of inflammation. There are people who do that because they are awake anyway. Or you could take a bit at bedtime, the rest in the morning. You can try it and see if it works - if it doesn't you can rethink after a few days.

Is the leg really the PMR I wonder. PMR does tend to be both sides, even if not equally. Could it be a low back problem causing sciatica? I have myofascial pain syndrome - which has a nasty habit of resurfacing as the pred dose is reduced. I'm lucky - my GP obliges with separate treatment so I get the oral pred dose down. There are practitioners in the UK who offer similar things to what she uses, though not many I admit.

[Roltuba in reply to PMRpro]

Thank you PMRpro, that's very helpful. Regards