Split dose question

[Leepeelee]

I am currently on 15mg pred, about to reduce to 12.5 (rheumy advise: rapid taper to help diagnosis ) I was having issues with returning Pmr Symptoms a few days ago. I have just changed pred dosage time from midday to 6am as advised from here, this does work better for me but instead of getting aches and pains at around 10 in the morning I am waking at around 4 am in agony.

This morning, I decided to split the dose, so I took 7.5mg at 6am and another 7.5mg at 4pm . I have no idea if this was the best thing to do but I guess I will find out tomorrow morning!

I am meant to be reducing by 2.5mg this Friday. Could anybody advise on spilt dose / times /whilst tapering ? I'm not sure if I'm doing the right thing

[PMRpro Ambassador]

"Rapid taper to help diagnosis" - if they say so!!!!

The usual sort of split is 2/3 in the morning, the rest later at a time that allows the effect to carry over to next morning. When that is depends on the person - but having it earlier rather than later may help sleep although a lot of people find that taking it just before bed doesn't disturb their sleep and the morning is good. Can't really be more helpful than that. Then a lot of people either reduce the morning dose or take a bit off each.

[SnazzyD]

Doesn’t sound like fun already. What is it going to take before they decide it’s PMR?

[Leepeelee]

He wants me to drop to 10mg. He said that he want to test me for RA along with various other possible conditions.

The symptoms that I have when they show themselves are shoulder and upper arm pains, neck ache, upper thigh pains, buttocks aches, groin aches and a fever type symptom. I don’t have any joint pain but sometimes I do get a ache in my forearms and wrists (I do have osteoarthritis in one wrist)

I just want a diagnosis so that I can get on the correct medication to control it.

Would preds work if it was RA?

[PMRpro Ambassador in reply to Leepeelee]

All that is very PMR-ish. If you don't have any joint symptoms - what makes him think RA?

As GoodGrief says, pred will help RA too but usually it takes a higher dose and longer to get a good response. Pred is used to relieve RA flares until adjustment of other medication kicks in. Any patient who doesn't respond to a moderate dose of pred should be considered for another diagnosis - and I think that at least some of the patients who respond well to the so-called steroid-sparers probably have RA. LORA (late onset RA) often doesn't show the joint erosion until a late stage, if at all and there are doctors who happily use low dose pred to manage RA patients who have no joint erosion or together with a DMARD to prevent that to get a better result,

[GOOD_GRIEF]

Yes, pred reduces RA symptoms, but alas the disease progression continues. And if it is RA, it doesn't necessarily show up in blood tests - referred to as sero-negative RA.

[Leepeelee in reply to GOOD_GRIEF]

How can he diagnose RA then? Is it often mistaken for PMR?

[GOOD_GRIEF in reply to Leepeelee]

Diagnosing autoimmune conditions is often a process of elimination. Symptoms alone may not differentiate. If seronegative RA, comparing current x-rays to those a year or two later are often what determines the RA diagnosis, as changes in the joints can be observed.

There are other conditions that have similar symptoms as well. Most will respond to pred, but pred does nothing for the underlying condition, just as in PMR.

If it is PMR, pred will halt or slow the progression to GCA. Generally, PMR by itself burns out, and leaves no lasting damage. If pred is managed well, is accompanied by the recommended supplements of calcium and Vit D, and a balanced diet reducing unnecessary carbs, the pred shouldn't leave a lot of damage behind either.

Regardless of the underlying condition, it is important to recognize that a healthy diet, rest, gentle exercise, and self care including avoiding injuries is paramount.

[Mack100]

When I was on 15mg pred. I was waking in the morning in a great deal of pain and stiffness, mostly shoulders and hips but also in my hands. After reading on here about when the body sheds inflammatory products (0200 to 0400 approx.) I decided to split the dose, 5mg before going to bed and the rest in the morning as usual.

The result was very good, no more morning pain, the downside is that I wake quite early, any time between 0400 and 0500. I'm learning to cope with this by getting up and doing things instead of just lying in bed.

If I feel that I am tired by 0800 or so then I go back to bed for an hour and sleep, this is useful as I sometimes get a fairly unpleasant prednisolone "head rush" for a couple of hours after taking my morning dose.

I realise that I'm very lucky to be able to do this, not everyone can manage this. Earlier this week I decided to be too clever and revert to taking the dose in the morning as usual to improve my sleeping pattern. The immediate result was a lot of pain and stiffness upon waking, I quickly went back to taking the split dose, lesson learned

[Leepeelee]

I woke up this morning with less pain & stiffness so I think that splitting the dose may be working better. I realise that it might be to early to say for sure but I’m going to stay at it for a while.

I have been getting some mild aching in my wrists, finger and toes. Very mild though.

I’m reducing preds today by 2.5mg as per Rheumatologist advise, fingers crossed this goes ok 😢

[Paperroses]

Ive been taking prednisone since May 2019 and always split dose . 8:am and again 8:pm. doctor told me to try it all in the morning when I was at 17.5mg. That was a disaster. Next morning I got up in pain and had dry heaves. went back to split dose. I tried it again in the morning when I was down to 9mg and had the same thing happen again. I always Take the morning pills with breakfast and evening pills with milk.