Little worried about tapering to 7.5mg prednisone

[jensen0518]

Brief background

Age 58

Diagnosed in December 2018with PMR

February saw Rheumatologist prescribed 30 mg prednisone

3/6/2019 20 mg, 3/26/3029 15 mg

5/5/2019 ran 10 mile race no problem,5/6/2019 10 mg so far no problems, 5/7/2019 no problems rheumatologist appointment blood work very hood C reactive protein 5.0 s little high doctor not concerned he recommended 2 weeks on 10 mg then taper to 7.5 mg on May 20 which is where I am now here is my concerns I have noticed that I am not in pain I will say in the mornings a little discomfort some things that were easy a week is not easy for example putting socks on getting out of my car I do have to say by like 1 everything is good I had to adjust I was taking the 7.5 at 10 now taking at around 4 am and I am feeling a little better in the mornings another concern I have is my hands are hurting more the left hand is week at times and the right hand my fingers are locking

Monday 6/3 I should taper to 5 mg which I don’t think I can at this time

My next appointment is 7/16

How much discomfort should I have when tapering to below 10 mg

Thank you

Jim

[Soraya_PMR]

You started quite high at 30 and your drop to 15 was speedy. That’s where most people start at 15, so maybe you’ve been given a false sense of security that reductions are ‘easy’.

However.......!

A one off higher CRP is not too concerning, what you need to know is the next CRP to see if you have an upwardly rising number. And while you wait for that it would be wise to stick at your current dose. PLUS you describe niggles returning, and those pains will just grow if you continue to reduce.

You were ok at 10, but not at 7.5, somewhere in there is your ideal dose, could be 9.5, could be 8.0. As you’re reducing fast and furiously you can’t know for certain what the ideal dose is.

I think that you should return to 10 until you feel as good as you did before, then drop to 9 and stick there for 3-4 weeks before trying 8.

Don’t even think of dropping to 5!!!

[jensen0518 in reply to Soraya_PMR]

Thank you

Totally agree with you

[PMRpro Ambassador]

You should never feel worse in terms of PMR-related things at the end of a reduction step than you did at the beginning. That is why we say drop in small steps and take a rest between drops to be sure the new dose is still enough. IMHO, 2 weeks isn't long enough and 2.5mg at a time is far too much at this level. No drop should be more than 10% of the current dose - 2.5 down to 20mg is fine, acceptable to 15mg, not any lower. And that is a figure from international experts in tapering pred. Tapering to titrate the dose is NOT the same as a reduction heading for zero.

As Soraya says the CRP may still be "in normal range" - that does NOT mean it isn't high for you, that it isn't in the process of rising because of increasing inflammation because the dose is now too low. You need to stay where you are at 10mg and check the CRP again. And then slow down to 1mg steps or use a slow approach to the taper.

[jensen0518 in reply to PMRpro]

Thank you i was in contact with my doctor and he said to go back to 10 mg and next taper down to 9 mg

[PMRpro Ambassador in reply to jensen0518]

Excellent