Flare

[Patience47]

Had flare early this morning. Increased prerldnisone from 7mg to 14mg, but still having headaches and neck pain.

My question is should I stay on 14mg or increase prednisone even more?

Comments greatly appreciated

[Car00b]

You don't say how long after you drop your tablets you think you have had a flare . For me I will have some sort of flare after 3 to 4 days I will then wait a while . Day or two by which time pain would have settled down if not a flare or else would have gone up to 10mg for three days and then come back down to 6 mg again . Stayed at that for 1 month and reduced by anothe half mg . I reduce half mg every 3 to 4 weeks .

It's not good to up and down tablets until you are sure it's a flare . Otherwise you get into a yo yo situation . Ask doctor or Rheumatologist nurse for advice

[Patience47 in reply to Car00b]

I understand, but I was so sick and in such pain it was either increase prednisone or go to ER. I've had two flares in three years, so I know when they are real or not. I believe I was on current dose for about six days before flare. I probably increased the dose too much. I once got down to only two mg, but it only lasted for three weeks.

Thanks for responding

[PMRpro Ambassador]

You should not blame every ache and pain on a flare and just kneejerk increase your pred dose. You can't really say that having a headache in the morning is a flare - a flare is a real return of symptoms over a longer period, at least days.

If you believe you are having a flare of GCA you need to discuss it with a doctor. I know you see people saying on the forums they are increasing their dose - but most of them have had PMR and GCA for a long time and are very aware of what is happening having been there before. Usually the first thing to try is a painkiller - even though they don't usually work for PMR they DO work for other things.

The recommendations from doctors are usually to add 5mg to the dose at which you flared and if that helps, fair enough. The odd one or two mg isn't a big deal, especially when it is during a reduction you notice symptoms starting to reappear. But if a flare reappears overnight - yesterday you were fine, today you are not, then you need to discuss it with a doctor.

[Patience47 in reply to PMRpro]

This was no knee jerk response. I should have included all my symptoms, severe pain in neck, upper arms, migraine headache, and unending nausea. The exact same symptoms that sent me this the ER.

Increasing prednisone is the last thing I want to do. I have Degenerative disc disease which is inoperable, so I'm quite familiar with aches and pains long before I got PMR. My question was how much to go up on the prednisone. The last flare I had I didn't go up enough and suffered for weeks.

[Patience47 in reply to Patience47]

I have had PMR going on 4 yrs now, so it's hardly new to me.

[BonnyQuine in reply to Patience47]

I have GCA, and only for 5 months. But what you describe seems very similar to what's happening to me. It's very disheartening, and difficult to know what to do for the best, when medics aren't easily accessible.

I had an unmistakeable flare, Wed - Fri last week, after dropping my Pred dose from 15mg to 14.5mg. Went back up to 20, then 17.5mg. Saw rheumatologist on Mon (by chance). Had a long, optimistic discussion. Told to stop splitting the dose, and to take 15mg all at once, early mornings. Fine! Except will be incapacitated by Pred wobbliness. Oh well . . .

Began having symptoms Mon evening. Woke in agony at 3am - took 15mg then. Woke again ~ 8.30am. Pain no better, esp jaw, neck and eye + temples. Took another 2.5mg + paracetamol + a blood pressure med + a diabetic med (steroid-induced diabetes). Woke again 11am. Pain not much better - dilemma - Am supposed to be managing fine now!.. Took another 2.5mg + paracetamol. Realised hadn't taken other diabetic med. Tested blood sugar (not lethal); drank lots of water and took other diabetic med w lots of plain Greek yoghurt. Stomach not happy.

Could I stand days or, worse, weeks of this? Desperate to reduce the pain, but also desperate to reduce the Prednisolone side effects. This dilemma has the longest horns.

Headache now subsiding to dull background ache (5pm). Jaw improved thank heaven. At the moment am hoping for the best. But will I be able to leave the next lot of Pred to tomorrow morning? Am apprehensive.

Ref Pred dose - your guess is as good as mine. Guess will have to agree to adding Methotrexate. Am watching your replies. . . .

One foot in front of the other . . . .

[Patience47 in reply to BonnyQuine]

Thanks so much for your response and comments.

[PMRpro Ambassador in reply to Patience47]

Same applies - if you have a flare of GCA when you are at this low a dose then you need to discuss it with your rheumy. As soon as possible.