PMR Flare, going up from 8 mg, a single day 15 mg, then?

[RedMaple]

I had been on 8 mg for 3 weeks and the pains started to become very bothersome. I planned to increase back to 9 mg. Reading the posts here I thought it may be good to have a large initial dose to remove the residual inflammations so I took 15 mg yesterday. It made huge difference and the pain is nearly all gone during the day.

This morning, I felt some minor version of the pain (I never had the stiffness most PMR patients have). I am debating what to do today: a) take 9 mg for 4 weeks, b) take 12 mg for 4 weeks, or c) take another 15 mg day to see.

The question here is, is the 15 mg initial dose too low to remove all the residual? What to expect when you hit the right dose (completely pain/stiffness free including early morning hours, or a little bit but not bothering your life)?

Thanks a lot.

[PMRpro Ambassador]

A little bit not bothering your life is fine - PROVIDING it doesn't get worse. If there is a bit of leftover inflammation the dripping tap will eventaully fill even an empty bucket and overflow.

I'd go back to 9mg - possibly with another high dose day if you feel you need it, but if you are that good and had been fine at 9mg before, why not aim for that and see what happens?

[RedMaple in reply to PMRpro]

Thanks. I already took 10 mg for the day. Maybe the leftover inflammation is too much, I feel marginally OK today. I will take a few more days of 10 mg and see.

[DorsetLady PMRGCAuk volunteer]

PMRpro took the words right out of my mouth!

A couple of days at 15mg should get a grip of things, and then you should be able to drop back down to 9mg - where I would stay for 4 weeks.

[RedMaple in reply to DorsetLady]

Thank you, Dorset. My 9 mg might be too thin on the margin. I will try 10 mg for a few days.

[daworm in reply to RedMaple]

well one of the tapering schedules posted was by a Dr. ( can't remember who) but its on this forum somewhere, he wants people to stay at 10mg for a year!! Seems long...

[PMRpro Ambassador in reply to daworm]

Drs Quick (she) and Kirwan (he)

I believe it works because they aren't trying to force a reduction at a critical stage of the autoimmune disorder. Once you force things and then get into a yoyo pattern with dosing you are in trouble.

Go slowly as we suggest and I believe it is possible to get to zero without ever having a flare if you are honest with yourself.

[podo]

After a flare in legs last November, I increased to 15mg for 2 days only and then dropped back to my usual 4mg. It worked a treat and problem has not returned so far!

[daworm in reply to podo]

my DR would NOT APPROVE!!! but what does he know, I've done similar and will again...why live with the flare when there is a solution...not to be careless with prednisone but what ever works as long as you try to get back down again..

[podo in reply to daworm]

An added bonus is that the cumulative amount of Pred is reduced compared with going to the higher dose and then going through the taper again.