Flare-up

[Reader7]

What causes a flare-up of PMR symptoms? The pain and stiffness is worse than when I was first diagnosed. I'm currently on 10mg prednisone.

[DorsetLady PMRGCAuk volunteer]

Hi,

A variety of things -

Not enough Pred - quite likely in your case if you were only startled in June on 30mg and are now down to 10mg. Much too fast a reduction;

Your body is not getting the full effect of the dose for some reason;

You are doing too much - your illness is not cured, it’s still there and you have to remember that - you cannot do all the things you did pre PMR - you need to build in rest periods during your day. This post may help -

healthunlocked.com/pmrgcauk......

However, I think the main reason is reducing too quickly - you’ve gone past the level you actually need. This might help -

healthunlocked.com/pmrgcauk...

[Reader7 in reply to DorsetLady]

Thanks so much for your helpful comments!

[PMRpro Ambassador]

Two reasons really, or maybe two and a half depending on how you look at it.

It may either be due to the underlying cause of the symptoms we call PMR, an autoimmune condition, having become more active so it is creating more inflammation which is more than the current dose of pred can manage - the answer is, you probably need a bit more pred.

Or it may be due to you having reduced your dose of pred a bit too far so the underlying disorder and the inflammation is now no longer managed by the amount of pred you are taking - same answer, you probably need a bit more pred.

The half answer is that you have been trying to do too much and your body is reminding you that it is under attack and is intolerant of acute exercise - slow down. More pred is unlikely to help.

You are never reducing relentlessly to zero - you are looking for the lowest dose that manages the symptoms as well as the starting dose did. That was your yardstick and at each taper you shouldn't feel any worse than you did at the start. At some point you will find a dose that isn't enough - you go back to the previous dose that worked. That is why we say to reduce in small steps - then you don't overshoot by much. It doesn't mean you won't get to a lower dose - just not yet. Often just waiting a couple of months may make the difference.

The underlying cause of PMR seems to vary in activity over time - so maybe yours has ramped up a bit and at the same time you have done too much? But it is impossible to identify it without more information. Like what have you been doing and how often/in what size steps do you reduce?

And having seen DL's reply - if you were only started on pred in June at 30mg and are already down to 10mg - that is the answer. You have reduced far too quickly and are on too low a dose to keep the inflammation at bay. A more usual taper would have had you starting at 20mg for a month or 6 weeks, 15mg for a month or 6 weeks, 12.5mg for a month and only then would you have got to 10mg - always supposing you'd not had a flare in the meantime. And once you take not quite enough pred - the inflammation mounts up quickly and you are back where you started.

I was given 2 weeks each of 15, 10 and 5mg. I was fine on 5mg - until 6 hours after missing the first 5mg dose. By the afternoon I was in bed, in tears with the pain. It too felt worse than before I started pred. I don't know if it was - maybe it was just the contrast in a few hours.

[piglette]

I cannot imagine going back to the pre PMR pain I was in agony, which you must be. As the others say dropping from 30mg to 10mg so quickly has probably something to do with it.

[Reader7 in reply to piglette]

Thanks so much!