Intermittent use of Prednisone

[Tpots]

Has anybody had any experience of taking 10days of Pred then a rest for say 2 weeks? I took it for 2 weeks so as to go on holiday and stopped it immediately afterwards with my GP’s approval. It took 10 days for my symptoms to really get hold of me again. Could this be an approach worth considering? I know it takes 2 weeks of Pred for the body to stop producing Cortisol so it’s within those parameters where tapering off is not essential.

[PMRpro Ambassador]

Long term I doubt it would work. The worst thing you can do is get into yoyoing the dose, going low, letting the inflammation cause a flare and going back up. For some reason it seems to make you need increasing doses to get the same result. What you are proposing is far more extreme than that.

If 10mg did the job for you straight off and it took 10 days for the symptoms to build up again it suggests to me that you will probably be able to manage the PMR on well under 10mg - 8mg is the equivalent of the amount of cortisol your body makes daily so isn't a concerning dose for anyone.

[Tpots in reply to PMRpro]

Thank you. That’s good to know. I started on 20mg but got it down to 15 in the second week. I really appreciate your input. Just fact gathering today! :). If I can amanage in 8-10mg this sounds acceptable to me. I guess I will find out very soon.

[Blearyeyed in reply to Tpots]

If it's PMR then No , this sort of system won't work because PMR is a self limiting disease and Pred is just the treatment for the inflammation and Pain not a , " cure".

While the PMR is " active" in the body taking intermittent Steroids will only cause the inflammation to be controlled while you take the medication then build up again in the weeks after.

Each time the Inflammation increases and you have to return onto Steroid Therapy the dose you need to take to get it back under control may need to both increase in dose and the length of time you need to take it.

This is why people who take their Steroids every day but taper the dose too quickly and get below the amount they need to control their symptoms often end up having a Flare in disease activity and "Yoyoing" up and down in steroid use. Increasing both the amount of Pain they suffer and having repeats if side effects that occur at higher doses , as well as causing a major impact on their Quality if Life.

If you allow the Pain and Inflammation to repeatedly build up you can actually cause yourself more physical and emotional damage than the possible side effects of taking steroids. This can also increase the duration of the PMR being " active" within the system , especially if Autoimmunity is a factor .

[Tpots in reply to Blearyeyed]

Okay. Duly noted. Thank you. I expect to be starting at 20mg, coming down to 15 as soon as I can and then be tapering very gradually to see how I do. Thanks so much!!

[PMRpro Ambassador in reply to Tpots]

Why not try 15mg first of all? That is the traditional starting dose for PMR and has worked for many of us. The 2015 Guidelines say the starting dose for PMR should be the lowest effective dose in the range 12.5 to 25mg/day. If there isn't a significant difference after a few days you can then go up to 20 - and it saves having to come down again.

[Tpots in reply to PMRpro]

It was my Rheumy who was keen on 20mg but I shall challenge that point. Thank you

[PMRpro Ambassador in reply to Tpots]

He may well be right - but it seems a shame not to at least try 15 with the option of going up.

[Hidden]

Sometimes Asthmatics have several courses like this, maybe over the winter or with a particularly bad chest infection but eventually it doesn’t do them any good as they begin to need higher/longer courses of Pred to get the Asthma under control.

So ultimately they may end up taking a lower daily dose until they become more stable.

My Mother’s Asthma was classed as ‘Brittle Asthma’ & was very hard to control, eventually she ended up on 60mg a day for a very long time.

So while in theory it sounds good, in the long term it would be counterproductive & maybe you’d need higher, longer doses.

Good Thought Though!

MrsN

[Tpots in reply to Hidden]

Okay. Thank you. Good information and really helpful!