Reduced Pred from 10 to 8 mg

[Sadie1024]

I reduced from 10mg and have been on 8mg prednisone for 21 days. Just started feeling a little pain in my shoulders, could it be inflammation building back up or my osteoarthritis? I thought after 21 days I would be ok on 8mg.

[Mikeysaab]

Hi just sharing my experience I found sub 10mg has been challenging and definitely aware of some minor PMR discomfort with some days better than others. They say 8mg is the typical threshold and getting under 8 can be difficult but persevere if you can. After some ups and downs I’m on DSNS path to 6.5 as next base. It’s difficult to know if it’s PMR pain or ‘old’ pain eg osteoarthritis reappearing and my Rheumi warned me about this. In fact he got me to make a note of where I experienced pre PMR joint pain as likely this will come back and need to remember where it was.

[Sadie1024 in reply to Mikeysaab]

I had no pain on 8mg until the 18th day on 8. I am still ok first thing in the morning but about 2 PM a little pain starts to come back. I take my 8mg at 2am.

[SheffieldJane]

This could be a warning that a 2 mg drop was too ambitious. At your stage I was dropping by 1 mg and staying there for a month, or even 0.5 mgs drop and not reducing again until everything settled.

[Sadie1024 in reply to SheffieldJane]

I think you may be right.

[PMRpro Ambassador]

After a reduction it can take time for inflammation to build up to a level you feel so I don't find it surprising - especially since you appear to dropped from 10 to 8? Or am I misunderstanding? From 10mg you need to look at steps of 1mg at a time - and from 5mg even less. No drop should be more than about 10% of the current dose.

[Sadie1024 in reply to PMRpro]

I did drop from 10 to 8mg. Should I go back to 10 or go up to 9mg?

[PMRpro Ambassador in reply to Sadie1024]

I would go to 10 for a few days at least (better chance of clearing out the aches and pains) and then try again. And remember - the dividing line is narrow: 10mg may be fine, 9mg may not. There's no hurry - it isn't a race.

[Sadie1024 in reply to PMRpro]

Thank you so much.

[DorsetLady PMRGCAuk volunteer]

Although it can be difficult sometimes to tell the difference between PMR and shoulder arthritic pain, I’m inclined to agree with S/Jane that the drop from 10mg to 8mg is too much.

You could try paracetamol or a gel to see if that helps the shoulders - if it does, then it could just be arthritis; if not, then it’s likely to be too low a dose of Pred.

But whatever, please start tapering more slowly - also as Jane suggests.

[Sadie1024 in reply to DorsetLady]

I tried 1300mg of Tylenol the first day I felt pain in my shoulders and it seem to take the pain away but today I took 1300mg of tylenol and I still have the pain in the shoulders.

I take my pred at 2am and the pain in my shoulders is gone by 10am.

[DorsetLady PMRGCAuk volunteer in reply to Sadie1024]

Then that suggests it’s PMR rather than arthritis. Maybe back up to 10mg to see if it clears - and then once it has reduce more slowly.

I guess you’re not in UK as you mention Tylenol- so maybe you are on 2mg tablets - but you do need to reduce slower, so you may have to cut them - provided they plain uncoated ones.

[Sadie1024 in reply to DorsetLady]

I have 1mg tablets so I can go to 9 after I clear the inflammation.

I don't know what I would do without this forum. Thanks so much.

[piglette in reply to Sadie1024]

As the others say, I would not reduce more than 1mg at a time. In fact .5mg seems to be even better under 10mg.

[Meggsy]

It took three attempts for me to reduce from 10 mg. Finally managed 9.5 and now tapering by 0.5mg. Presently 3 weeks on 8mg - diagnosed Feb 2018 - starting dose 15 mg, not enough so GP upped it to 25mg two weeks later which did the trick. 10 mg has been the only glitch so far. Fingers always crossed. All the best Sadie 1024 - Marea 🌻

[Sadie1024 in reply to Meggsy]

Thank you so much.

[Hidden]

I also took a couple of attempts to get from 10 to 9mg and on. I had to do a slow taper using 0.5mg before it stuck. I think you know for certain now that 2mg drops at 10mg don't work. I think your "record" of when pains started and painkillers tried etc. Provides you with a clear timeline on the build up of inflammation. I always found it was around 2 to 3 weeks that I knew for certain if a drop had taken. As people have said it not a race. I have been at 6mg since last September and will be on at least that until December '19 when I see Rheumy. I am happy at that dose at the moment and seem to have minimal side effects if any.

[Sadie1024 in reply to Hidden]

Thank you.

[Mimma]

Very interesting to read your post. I have been on 8 mg for the last two weeks and have definitely felt some symptoms reappear - some joint pain and tiredness. Due to drop to 7 mg in two weeks.

I think a 2 mg drop may have been too ambitious at your stage?

My rheumatologist advised dropping by 1 mg each month after 10 mg.

He started me on 15 for two weeks and then down to 12.5 for two weeks after that to 10 mg thereafter reducing by 1 mg a month.

Maybe try every alternate day? 9 mg one day and 8 mg the next? Have read on this feed that this method works for some.

Good luck.

[Sadie1024 in reply to Mimma]

9 and 8 was what my Rhuemy also suggested. Thanks. I am also going to go back to the DSNS method once I get back to no pain.

[PMRpro Ambassador in reply to Mimma]

It may - but even slower works even better once you are below 10mg. Although it is very much more gentle this

healthunlocked.com/pmrgcauk...

still allows you to reduce 1mg a month so you are always only a month behind what you doctors want and it is more likely to work than sudden drops.

[Mimma in reply to PMRpro]

Thank you

[Telian]

As others have said you’ve taken too big a drop. I would go back to 10mg and stay until all symptoms have gone then start a slower taper. It can take much longer than your previous tapers as you get lower.

All of us have been advised it gets harder the lower you get but you can still get there but at a much slower pace. I got to 3mg once and had to increase to 5mg. It’s taken a year to get to 4mg. I’m 5 years GCA/PMR.

Monitor your pain using a diary - you might then see a pattern - better than trying to remember at a later stage - steroids aren’t the friendliest when it comes to thinking!

Once you find a level that suits you don’t be in a rush to go further - you’ll get there if it’s intended!

Best wishes.

[Sadie1024 in reply to Telian]

Thank you so much. I know now I have to slow down.

[Thelmarina]

My rheumy told me to stay at 10mgs for at least six weeks and I shall take my time. Thereafter I shall drop .5mgs at a time, taking plenty of it 😀. Poor body is doing its best and I try to be gentle 😀😀

[Sadie1024 in reply to Thelmarina]

Thank you, I am going to slow down.

[navejasjoe]

We found that my wife's tapering has worked best when reducing by one half of one mg at a time. In other words, going from 12 to 11 resulted in pain she did not experience at 12, but when she went from 11 to 10.5, there was hardly any associated pain. Now she is on an alternating schedule of 11mg one day, 10mg the next, and so forth.

Joe