relapse PMR

Hi everyone, can anyone advise please I have been on 15ms Prednisolone for one month Doctor advised cutting down to 13mgs which I have done. Now on day 3 and slight symptoms have returned. Was it too soon to reduce dosage? your help please and thank you

[DorsetLady PMRGCAuk volunteer]

Hi

It may have been, how where you before reduction- pain free or not?

You might be doing a bit more because you feel better in yourself-

Or it may be steroid withdrawal.

If it is steroid withdrawal it should go within the next couple of days.

If it doesn’t get better, then you’ve probably reduced either too much or too quickly.

If you’ve done that, you probably need to go back up to 15mg - get stable and then reduce by only 1mg,

You are not reducing relentlessly to zero - and you need to manage your illness and your activities.

Have a look at this -

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

DL has said it all: above all, if the niggles you are feeling get worse rather than better, back to 15mg for a few days and do 1mg next time. Personally I think 2mg drop after only 4 weeks at 15mg is probably a bit much for a lot of people.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Totally agree!

[Louisepenygraig]

I'm confused by your reply that Prednisolone might not be the best approach? What would you recommend instead? Also 15 to 13 mg is larger than the 'no more than 10%' rule so it is a little large. My rheumy recommended 1mg at a time down to 12mg and then 0.5 mg after that.

[Hidden]

thank you all for your comments

[PMRpro Ambassador]

Is there another approved and available approach for PMR?

If a dose is slightly too low and allows inflammation to build up again the patient is likely to end up back at the state they were pre-pred. You will find plenty of people on the forums who ignored a little bit of discomfort only for it to mount up to a full-blown flare. So that is not just my opinion.

[PMRpro Ambassador]

Pred isn't contraindicated if it is the only option - there are other medications that can be used to manage the osteoporosis and there are patients on the forums who are on both. One of the major risk factors for lost of BMD is immobility - as is almost inevitable in full blown PMR.

[HeronNS]

I started at 15, stayed there for five weeks, then tapered by 1 mg per week. At 9 I felt niggles so went back to 10 for a couple of weeks then started the dead slow nearly stop taper. I was to 3 mg by the end of the first year and my lowest best dose appears to have been around 2 or 2.5 for a couple of years. Working down further now, but excruciatingly slowly! I've nearly always had niggles but I never tapered if I began to feel worse towards the end than I had at the beginning. I also have fairly extensive osteoarthritis which can account for much of the niggles.

I did take a copy of DSNS taper to ask my doctor's opinion and she okayed it but I intended to use it anyway. ☺