when my wife's prednisone taper from 12mg to 11mg became too painful after 2+ weeks, she went back to 12mg. In her next rheumatologist appointment, she was asked to toggle daily between 12 and 11, but was prescribed a daily dose of Meloxicam (7.5mg) to be taken with her prednisone dose. This was done as an attempt to minimize possible effects from the tapering effort. We were wondering if anyone has had any experience with Meloxicam.
The rheumy's long term plan is to eliminate prednisone as soon as possible without bringing back the PMR symptoms. My wife was diagnosed with PMR 2 years ago and we understand any tapering has to be in very small amounts, and it could take many more years before prednisone can be stopped completely.
Joe
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navejasjoe
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Did you mean Meloxicam? I have looked it up and it is just a nsaid which usually don't work for PMR and are contraindicated with pred. From what I see it's like taking ibuprofen but I could be wrong. Not sure how much that would help in the long run. Is your wife having bad side effects with pred or is it the usual get us off as quick as possible?
Thank you Poopadoop. My wife is not having bad side effects with Pred. It's just that she is trying to see how best to manage the taper process. Going from 12 to 11 did not work; we will see if 12 one day, 11 the next, and so forth will work. The rheumy feels that perhaps the Meloxicam will "lessen" the intensity of the pain my wife felt when she tried to taper with 12 to 11.
From our own experience and from what I have read in this wonderful site, there are many good rheumys out there and some very misinformed rheumys. The guys my wife had a couple of years ago thought that good ESR and CRP numbers meant the PMR had been cured. The lady rheumy we have now is very cautious with the tapering process - to be done in very low increments.
It might be the Rheumys plan to eliminate Pred asap, but if he doesn’t tell the PMR that, it’s unlikely to work! So long as your wife has PMR she needs the correct level of Pred (for her) to help, and that might be anything between 2 -6 years.
Some doctors introduce a drug called a DMARD to help with the reduction, but as Poopadoop says don’t think Meloxicam is one, and if it’s a NSAID then it shouldn’t be used alongside Pred as it can cause stomach problems. Think you need to check things.
Thank you DorsetLady for that insight. I just read the side effect potential with Meloxicam and it does speak to gastric issues. I don't think my wife wants to deal with that, especially since you say that taking it along with Pred is not good. It's been a week since the toggle began, and she has yet to start on Meloxicam because I wanted to see what you guys, the "real" experts believe. Maybe I'll have her hold off.
"The rheumy's long term plan is to eliminate prednisone as soon as possible without bringing back the PMR symptoms"
I think you will find that is the long term plan of EVERYBODY, especially patients - although the way some doctors act you'd think we LIKED being on steroids. While there is probably a role for NSAIDs in PMR for dealing with the discomfort of steroid withdrawal, if the reduction is done slowly enough (i.e. in terms of the size of step down) then there should be no need. And doing it that way has no potential side effects.
Meloxicam is an NSAID, not generally advised alongside corticosteroids because of potenital gastric side effects being increased with both being used together. I belive meloxicam is claimed by the manufacturers to have fewer gastric effects - fewer is not none.
As has already been said - since the PMR is a long term condition (average duration 5.9 years) and the pred is only managing the inflammation caused by an underlying autoimmune disorder (PMR is the name for the symptoms not the disease) and only pred manages the inflammation of PMR, as long as the underlying cause is active, your wife will need pred. And nothing the rheumy can say will change that.
When the pain returned after 2+ weeks it suggests it was not pain due to steroid withdrawal, that would have happened immediately or almost immediately. When the pain returns after a couple of weeks it is a sign the dose is not quite enough to manage the daily dose of new inflamamtion and it has now built up to a level where is is causing swelling and pain. Meloxicam is unlikely to change that.
Thank you, PMRpro. As I mentioned on DL's response, I do value the opinions of you folks on this site, and we were holding off on beginning the Meloxicam. At this point, we feel that 12mg daily has been her "magic" number, at least for being able to function relatively well. Not nearly as well as pre-PMR, but reasonable enough. Toggling from 12 to 11 every other day may work, but it has only been a week.
Given the insights provided here, we will wait to see what effects the toggle has. The rheumy my wife has now is a world of difference from the "idiot" rheumy she had before, and I know the current rheumy means well. She is very sympathetic to my wife's situation. Maybe it's being a woman, and from what I can tell on this site, it is mostly women that are dealing with this ugly disease.
I think it is somewhere between 2 and 3 times as many women as men develop PMR/GCA.
Hi Joe
I take Meloxicam along side my Prednisolone for my knee pain. This is since l had Chemo which caused damage behind the kneecaps, l have had no issues with it.
Maybe instead of toggling between 12 and 11 she might try the dead slow nearly stop method or a variation. 12 11 12 12 12 11 12 12 11 12 11 11 12 etc. so she just adding one or two of the new dose each week.. a little slower. But given she has had symptoms I think perhaps a week or two at 12 solidly and then start the new taper more slowly.
Thank you Yogabonnie. It's been a week since she began the toggle (12, 11, 12) and has not had the symptoms. When she recently went from 12 to 11, it took her 2 weeks to feel the symptoms. So we'll see how this goes. If the symptoms return, your suggestion surely sounds like the next step.
It doesn't matter how slowly you reduce - if you get below the dose you need, the inflammation will resurge. At present she is effectively taking 11.5mg - if 11.5mg is enough to mop up all the inflammation that will be fine. If she progresses to 11mg and that is too low do do the job at present, there will be a flare sooner or later.
Yes. I take 7.5 mg of Meloxicam as I have tapered down to 2 mgs. It does help. However, long term use (from what I have been told) is harsh on the kidneys.
I was diagnosed APRIL 2017. I had both my knees replaced at a he same time in 2015 and we think it caused undo stress on my body. It is vitally important to taper exactly as described by your rheumatologist. Melixican also known as Mobic has helped a great deal. However to tell you the truth, I think PMR patients will always feel twinges of aches and pains. It is the ESR reading that truly can determine if you have PMR. I take 1950 MHS of Tumeric, pure organic and clean 2 times a day. It helps! Also I take calcium and other pure supplements that help further reduce the symptoms. Do your research. Take Vitamin D to protect the bones.
We have found that the ESR reading tells you the level of inflammation at the time of the test. Prednisone reduces the inflammation and thus improves the ESR reading, but having normal ESR does not mean you no longer have PMR. This was made clear when my wife's first rheumy interpreted the ESR normal reading as having "cured" PMR and he told her he could no longer do anything for my wife. We now have a much more knowledgeable rheumy.
When the levels return to normal it simply means you are in remission. You have to eat “clean”. Organic foods organic hormone free poultry and chicken. No sugars. This can help. And activity. She needs to exercise but not overdue it.
" It is vitally important to taper exactly as described by your rheumatologist"
On this forum - and others - you will meet plenty of people who will disagree with you as their rheumatologist provided them with totally unreasonable reduction schemes that doomed them to flare after flare until they stopped using them. Unfortunately not everyone is as lucky as you have been.
And, just as unfortunately, the ESR and CRP do not provide conclusive proof of PMR: up to 20% of patients with PMR never have raised markers.
As I say - you are very lucky. But many patients have doctors whose only aim is to get them off pred asap - so doing exactly as the rheumy says isn't always the answer.
Sounds like your wife needs to stay on the 12 until she feels comfortable again and then start the taper, but from what you say the 'toggle' taper is not for everyone, certainly not for me. It needs to be a much slower one similar to what yogabonnie has mentioned - my rheumy asked me to do a toggle reduction it was a definite no no for me and I only reduce once weekly at the moment. This is my third week and I had no symptoms this time. Next week I will come down to 6 days for at least 2 weeks and so on as long I only get the few hours withdrawals - should that change again then I will stay put and continue when my body allows it. I have tried all ways and in my 4th year now I know my body - I am lucky my rheumy agrees how I do it is up to me as long as I can try to get lower than my current dose.
Best wishes Joe, you are a good man looking after your wife so caringly.
Thank you for your ideas and thoughts. You and Yogabonnie are giving us a lot of food for thought in regard to the tapering process. And it sounds like you have a good rheumy, like what we think we have.
I started on Meloxicam about a month ago to help w/ issues I have in my fingers, hands & wrists. I take one 7.5 mg tablet @ night & it has helped some w/ pain. As far as assisting w/ the flares when cutting bk. on my prednisone I’m not sure how that will go as I will be cutting bk. for the 1st time since on mobic (Meloxicam) tomorrow when I decrease from 12.5mg a day to 10. I’ll keep you posted.... However the advice you get from folks like DorsetLady, PMRpro, poopadoop & others are priceless. Those folks are such a blessing....
Thank you LarryLeek. I fully agree with you about the lovely ladies on this site. It's like having a PMR encyclopedia at our fingertips. Wait . . . .am I aging myself? Do encyclopedias even exist anymore?
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