PREDNESOLONE MAINTENANCE DOSE

[JOHNONE28]

I have been treating my PMR with preds now for nearly 5yrs &, on two previous occasions having being as low as 2mg & then due minor flare ups or on one occasion due to a"uti" infection" having to increase the dosage again. Just recently I managed to reduce to 11/2 mg & maintained the reduction for about 5 weeks. I then went on Holiday ( from which I have just returned ) unfortunately I suffered an heavy fall at the beginning of my Hol (no serious damage ) & then picked up a chest infection just after, i then started with what j thought was the " flu" but realised after a couple of days the symptoms where due to a "flare up of my PMR. I then increased the dosage of my preds, having to increase in stages to 15 mg to regain control of the flare. How long should I stay on this higher dose & then manage the reduction ? also in the past on discussing reductions with a previous GP saying to him that I was looking forward to the day that I was able to come of preds he replied that I may never be able to come off them completely. Should I keep persevering with trying to reduce ? or what would be a satisfactory maintenance dose ?. Up to now all my GPs have allowed me to manage my own preds. After 5yrs I am now beginning to wonder if in my case PMR is for life.

[PMRpro Ambassador]

Your holy grail dose would appear to be 3mg, possibly 2mg: the lowest dose that manages the symptoms as well as the starting dose did. If you try to force past that all that will happen is that the inflammation will build up, like a dripping tap fills a bucket, and you will eventually develop symptoms again.

I suspect it is unlikely you really need to go all the way back to 15mg for long. 10mg may well be enough and possibly even less - many doctors suggest adding 5mg to the dose where the flare occurred. On that basis 7mg may be enough. And you may not need to reduce slowly all the way down, a week at the higher dose may be enough to clear out the accumulated inflammation and then you can drop straight back to 3 or 4mg.

It doesn't mean you WON'T get past 3mg, it means not yet. An Italian study found that approximately a third of patients still required pred at 6 years - but it is thought only about 5% of patients remain in pred for life. You still have some chance of getting off pred!

But these are very low doses, well below the physiological dose and unlikely to lead to long term problems.

medpagetoday.com/rheumatolo...

[JOHNONE28 in reply to PMRpro]

After consulting my GP & taking in your reply I am going to try reducing down to 3mg & then maintain the dose for at least 3 months before trying any further reductions thanks for your considered reply. Hope to be on 8mg tomorrow.

[Grants148]

I am sorry tthat you have been having a bad time lately ,l hope things improve for you soon. I am on 3mgs of prednisolone and although l still am not feeling completely free of thePMR,l cannot seem to reduce the dose to2mgs as it flares up too much. I think that you would be feeling OK on 3mgs, you have been taking the preds for a long time but like me may not be able to come off them completely,My GP has said that 3mgs should not cause any harm as it is such a low dose.Please let us know how you are getting on,l hope you feel much better soon.

[PMRpro Ambassador in reply to Grants148]

The pred has done nothing for the PMR - it is only managing the inflammation. It isn't a case of "still..." You started on a dose that was higher than you needed and the result you got them was your guide: you are looking for the lowest dose that gives the same result. Lower than that and you are allowing the inflammation to get a hold. You would probably be so much better if you went back to 4 or even 5mg - and they are also very low doses.