Flares

[aladymo]

Will a flare go away on its own without increasing the prednisone?

[piglette]

In my experience once you get a flare the PMR has got the upper hand. To slap it down you need to increase the pred for a while to ensure it does not get the upper hand.

[HeronNS]

I tried by not increasing enough and in the end I needed more and it took longer than if I'd just knocked it on the head for a few days at the beginning.

[Angiejnz]

Not in my experience and because I'm a slow learner and find pacing myself really difficult, I'm queen of the flares 😂 It always takes an increase in pred to put the jack back in its box. PMRpro gave me the best incentive to get the flare under control by reminding me the damage caused by out of control inflammation far exceeds any side effects of pred. Good luck with your jack 🤣

[Maisie1958]

Will be interesting to hear the replies as my PMR seems to wax and wane even at constant prednisolone dose and no outside stresses. I have to admit I haven’t toughed it out long enough to see if a flare would settle without increasing my steroid dose a little atleast for a short while. Maybe it would eventually....... but at what cost to your health? Especially if you have GCA/LVV.

Thank you for asking this. Atb.

[Ezio100 in reply to Maisie1958]

Me too, still on a relatively high dose and endure settled and flares at regular intervals

[Hidden]

Not usually, more likely to get worse, so often best to step in quickly......

[GOOD_GRIEF]

Well, no. See, the pred controls the inflammation levels. When your level is up, the only way to get it down again is to increase the pred. The trick is to go up to the dose where you last felt comfortable, sit tight for a while until it does its thing, and then start tapering in very small increments over longer stretches. Don't go down again until you're comfortable.

Going slow usually results in taking a lot less pred overall, as well as an easier course of the condition, which isn't going to give up until it's good and ready.

Search the site for DSNS - Dead Slow Nearly Stop plans. You might have to try a few before you find one that owrks for you. And don't be stock on just one plan. You might need different ones at different stages.

[DorsetLady PMRGCAuk volunteer]

Highly unlikely! Best to get it sorted quickly before it starts to do any harm to your body.

If you react quickly enough you shouldn’t need to be on a higher dose for too long before you can drop back down again.

The longer you leave the more Pred you are likely to require.

[PMRpro Ambassador]

It will depend why you are flaring really.

If you have a cold or other infection or if you have overdone things a bit you may have a short-lived flare that then fades over time. If it is because you have overshot the dose you need and are not taking enough pred, the inflammation will build up and the flare will progress. If the disease activity has increased, then you will need more pred to manage the inflammation or the inflammation will build up in the same way.

And when you think you are flaring and recovering repeatedly - are you sure it isn't a case of you have a good period and do too much that makes you ache, when you ache you rest and go into a better period. Rinse and repeat...

[Valnvaughan]

If I can identify a cause for a flare, then I add extra Pred that day. If there is no obvious cause, I brave it out and see what it’s like the next day. As Maisie1958 says this PMR can vary just on its own. Valerie

[Noosat]

I am not as experienced as the others here. I had a flareup after a few days of eating too much hugh sugar birthday cake (mine) over a 2 day period. I immediately went up to previous dosage, which brought down the inflammation. I am now gradually tapering again.

[aladymo]

I also started a PPI at the same time the hips and legs started aching. Maybe it’s a side effect to that and not a flare.

[HeronNS in reply to aladymo]

Could be. Can you discontinue the PPI and take something else for a while to see if the symptoms abate?

[Deb61]

Hi aladymo

This is such a great question with not an easy answer in my opinion. No I do not believe a

flare will go away on its own. Having said that sometimes it is difficult to know if it is truly a flare or your body adjusting if you are tapering. I have GCA and was diagnosed in 2015. I was quite ill and struggled for a number of years. I have totally come off of the prednisone as of Jan 1st. However it took me since 2015 to taper to zero. I had problems with relapse in the beginning as the doc pushed to taper way too fast and I had to go back up on the dose to get the GCA stable again. I had very many side effects from prednisone but knew I needed to be on it to treat the disease. I worked very hard to find good docs who would support a VERY slow taper and I did eventually find a great rheumy who consulted with myself and my GP and I also worked with a endocrinologist. With their support my taper was very slow. It took seven weeks to lower my dose - one day new dose, then next six days old dose, next week 2 days of new dose five old dose alternating days for dosing and on till I had a full week of new dose. Once I got to 8 mg I slowed even more by lowering .5mg where prior had been 1mg. Sometimes i would stop with the new dose for 6- 8 weeks depending on how I was feeling. I found every time I lowered my dose my crp would go up a bit. But if it stayed higher I would stop at the new dose until it leveled out again. My body let me know but I often found it difficult to tell the difference between a flare and side effects of tapering.I won't tell you it was easy because it is probably one of the most difficult things I have EVER GONE THROUGH. I don't know what was worse the disease or the taper! I would not have been able to do this without all the great doctors who listened, and supported me and the support and great info on this site!!!! The endocrinologist was very supportive and thought I had done great job with my taper. I had my cortisol levels checked and they had recovered a lot more that they thought but said a slow taper really helped. Also it has been determined by the specialists my cortisol levels are also able to make more cortisol when under stress. Soooo sorry it was such a long answer but it is not as long as the disease lol

SO BE PATIENT AND GO SLOW

So for now at least my GCA seems to have burnt itself out!!!!!

PS I feel great!!!!! but alas still old!

[aladymo in reply to Deb61]

Terrific answer. Thank you.

[Telian in reply to Deb61]

Well done Deb, that's the only way to do it!

[Sharonlh]

Hi , gosh I don’t know . I started on prednisone 2 years ago at 15 mg and have slowly reduced down to 4mg . If I’m in a lot of pain I go up a few mg’s . My doctor wanted me on 8-10 mg’s But I try to stay as low as possible . I’m not a real expert and have only posted once and didn’t really get many replies. I’d suggest posting this question so the experts like PMRpro could advise you . In My experience if I really get a lot of pain and stiffness I do increase 1 or 2 mg’s . And then try to slowly , very slowly decrease . I hope that helps .

[Klah]

I did need to increase the prednisone if I had a flare...usually just 1 more milligram. But if I flare and don’t do anything, the flare could last a week or more and then I would have to go up 2-3 milligrams for a short time.

Of course I needed to stop all activity during a flare too. Learning to recognize prednisone withdrawal vs a continuing flare can be difficult.

That’s why there is no point in rushing the process. Pred dose management is dependent on your activity/stress level....not by the calendar😊 PMR has a schedule of its own...you are just managing the symptoms. Don’t be discouraged...