Reducing Pred and flares

[Ndnd]

I have been trying to reduce Pred from 10 mg to 9 since beginning of January on a very slow taper but am having recurrent aching limbs & fatigue. First diagnosed in August 2019 . Previously went from 10 to 9 with no problems but flared when went down to 8, so back up to 10 last November. Any advice please on if I am trying to reduce too quickly?

[DorsetLady PMRGCAuk volunteer]

As you were only diagnosed in August, you probably are trying to go too fast at this point.

Just stay out at 10mg for another month or so, then try again, and maybe just try 0.5mg at a time, not 1mg.

You really are still at a very early stage, so there’s no rush.

[Ndnd in reply to DorsetLady]

Thank you. I also used to to etericoxib for arthritis before my pmr diagnosis, but my GP has advised not to take this unless absolutely necessary so I’m not sure if the pain & stiffness may be associated with that too. Not sure whether to re introduce it occasionally & see if that helps too. I will stay on 10mg Pred now & try again next month

[DorsetLady PMRGCAuk volunteer in reply to Ndnd]

No personal experience of etericoxib, but as it’s a NSAID it shouldn’t be used with Pred as your doctor has advised especially as it’s in tablet form.

Sometimes a gel or cream NSAID like ibruprofen can be used sparingly, but even with that you really should check with GP.

[Ndnd in reply to DorsetLady]

The GP did say I should just try to manage with paracetamol but I will certainly ask about topical NSAID & keep off the etericoxib

[PMRpro Ambassador in reply to DorsetLady]

Not an NSAID, a cox-2 inhibitor, but still an increased risk of gastric bleeds when combined with steroids. Just because it is said to be less bad for the stomach doesn't mean it is safe!!!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Ok thanks. - my mispelling - brought up info on Etoricoxib! Yet try harder!

[PMRpro Ambassador]

Probably not in the sense of you have been where you are long enough to try another drop - but it may well be you have reached "your" dose for now. It will vary over time, hopefully always getting lower, but it will depend on the activity of the underlying illness and at the moment it wants maybe more than 9mg. It doesn't mean you won't get lower, just not yet.

[Ndnd in reply to PMRpro]

Thank you. I suspected that I might be trying to reduce too quickly & my GP also advised that I stop taking the etericoxib that I had for arthritis unless absolutely necessary so maybe I will re introduce that for a couple of days & see how I go. This forum is a godsend for advice and support

[PMRpro Ambassador in reply to Ndnd]

Careful with the etericoxib - if 1mg more pred replaces it, that is, in the long term, safer.

[diana1998 in reply to Ndnd]

I only reduced by 0.5mg per month at your level. Much more likely to be successful.