Reducing Prednisolone

[Jenden]

I have now been on Pred for PMR for 5 years. I managed to get down to less than 1mg a day when PMR crept back - so was back on 15 mgs - 3 years ago. Since then I have had another flare up and back up to 15 mgs . Last year I managed to get down to 6 mgs and had all sorts of pains in muscles and joints so crept back up. This year I was realy well on 9 mgs but my GP wanted me to decrease quickly - I told her 1 mg in 2 weeks was far too quick! I thought getting down to 6.5mg in 3 months was good but on tapering to 6mgs all the joint/muscle pains have returned. I saw my GP 2 weeks ago - my CRP was up to 9 ESR 22 - she said it wasn't conclusive that the PMR was active and just to increase to 7mg for 2 months. 2 weeks later I have increased it to 8mgs due I to still being in a lot of pain - although it now disappears around midday - so my afternoons are relatively pain free. I am seeing a different GP on Monday and would grateful for some advice as to how approach the situation with her.

[PMRpro Ambassador]

For goodness sake "she said it wasn't conclusive that the PMR was active and just to increase to 7mg for 2 months" - what on earth does she want more conclusive than return of symptoms and increasing inflammatory markers on reducing the pred dose? It is the ONLY way of seeing it, there are no other ways of measuring it. Recent work shows that the median duration of PMR is 5.9 years - so no surprises to me you still have it:

practicalpainmanagement.com...

You are never reducing relentlessly to zero, you are looking for the lowest dose that manages the symptoms and since you flared at below about 8mg twice that is probably it. After a flare it is often harder to get things under control. You did well getting to 1mg - but it was probably at a relatively inactive period of the autoimmune part of PMR. It does seem to wax and wane with time - it isn't unusual for people to get to a lower dose and have to go back up a bit later. And now, after 5 years, it is going to take you longer to reduce lower than where you are at present simply because of adrenal function returning - and that GP should have known that.

I don't really know what to suggest - except to hope the other doctor has a bit more sense. If she has but is still "but PMR doesn't last this long" show her the link I have given you. Then work from there. Have you ever seen a rheumatologist?

[Jenden in reply to PMRpro]

Yes I have seen a rheumatologist and she was happy for me to continue managing the reductions according to how I feel. The Gp thought she might refer me back to her to consider a different treatment - but I am not going to consider anything else. I just want to get back to a level where I was really well - which would have been around 9 mgs last March!

[PMRpro Ambassador in reply to Jenden]

Different treatment? What is she thinking of? PMR is managed with pred. After 14 years of PMR and 9 years of pred currently 9mg is the right dose for me - and my new rheumy is getting itchy. Four weeks of methotrexate was more than enough. Next please...