Reducing

[Robinsnest72]

Could someone please tell me the reason for reducing prednisone slowly? Is it because of the withdrawal side effects or does it effect the inflammation coming back when you reduce too quickly?

[SnazzyD]

Hello, there are a few reasons

1. It lessens the chance of withdrawal symptoms where the body reacts to the sudden drop of cortisone which has powerful effects all over the body.

2. You are trying to find the lowest possible dose that controls the inflammation from your PMR/GCA. If you go too fast you may over shoot that point and if the jump was too big you won’t know that point very accurately. For example if you jump from 20mg to 10mg instead of smaller steps, the current minimum dose could be anywhere between those two doses. You then risk having to go up higher than you need when you try to get things under control.

3. At doses below 10mg a slow taper is needed to avoid adrenal crisis. The idea is that you tempt the adrenal system awake by metaphorically putting on the coffee and cookies downstairs rather than throwing open the curtains after a bucket of cold water. At worst, if you drop steroids too quickly and the adrenal glands don’t start making up the shortfall, it can be life threatening.

4. This is my theory now - I wonder if we get some rebound inflammation if we withdraw that which has been damping it to quickly. A bit like not stopping certain stomach acid meds suddenly.

[Jackoh in reply to SnazzyD]

Love the analogy!!

[jinasc]

SnazzyD has explained it well. I will only add

Fast tapers lead to yo-yoing doses of pred , eventually you end up taking more pred than you would have done, taking it slow and steady and listening to your body.

Yo-yoing can also lead to PMRs big sister coming along..............

[powerwalk in reply to jinasc]

Jinasc, What kind of yo yoing? Do you mean costantly putting up the dose? I havent heard that before. I know ive been locked in this for a while. Having to put pred up for a bit, then taking it down. Thanks.

[Hidden in reply to powerwalk]

Yes. It's about reducing too quickly then having to go up and reducing too quickly again. I was at 6mg for a year then had a flare when I was ill. I did a short blast 3 to 7days then went back down to 7mg rather than 6mg. But in the 3 and a half years I have had pmr I have gone up 4 or 5 times usually having been on a dose for at least 3 to 4 weeks and sometimes longer. If you reduce before the flare has eased and all Inflammation (more or less) is eased then you yoyo back you again. I have been at 7 for a couple of months maybe and no intention of reducing yet. Fortunately I am in a position to do that as rheumy happy for me to adjust. If every few months you are changing dose down and up several times you arent allowing pred to do its job. I only up the dose if I have pmr symptoms and don't go down until I can't feel any. 😜🌻

[powerwalk in reply to Hidden]

Oh right. Thankd Poops, Honestly i dont even know whats the PMR symptoms anymore, is it the hand pain, or the back pain or foot pain!!! Or the exhaustion!! Its a bit of a minefield at times.

[Hidden in reply to powerwalk]

Could be all of them. I was several weeks with increased pain before I increased as I am never sure if OA in spine or fibro. I did the plus 5mg and most of it went.

[powerwalk in reply to Hidden]

Thats good. Can only do our best. Thanks.

[jinasc in reply to Hidden]

Thanks Poopadoop 🤗

[Hidden in reply to jinasc]

That's okay I hoped you didn't mind. I had typed most of it before I realised direct question! 🌻

[jinasc in reply to Hidden]

I never ever mind, it saves me answering and the person needs an answer asap.

I opened up to shop on line. when I noted the notification 😊

[Hidden in reply to jinasc]

Hope you got some nice things 👍