Returning to higher dose after long taper schedule for flareup

[AdoptMeow]

What dose to go back to when PMR flares at low dose? Several members responded to "risk factors" stating they flared when tapered down to very low dose pred. What dose did you return to that was effective? And how long was it needed before starting taper?

[DorsetLady PMRGCAuk volunteer]

I think you’ll get as many answers as there are responders - everyone is different.

General rule of advice is to go to at least 5mg above the last level you felt okay at - so as an example if you’re at 2mg and not too good but felt okay at 3mg - then go to 8mg. Stay there for anything between 5-10 days depending on how long it takes to feel better.

If you only need 5 days, then you can probably drop back down to just above the level that caused the issues, but not to the dose that was obviously too low.

If it takes longer to get things under control, then it’s probably better to come down in two stages - say a week at 6mg, then another week at 4mg before tapering again.

[PMRpro Ambassador]

How did it flare? Was it because you overshot the dose you need and didn't notice for a few weeks? Or have you been on a steady dose for a while and the disease activity increased? Or had you been under stress or overdoing it?

If you don't really know, then a good start is to have a week at 5mg extra (so if you were at 4mg, try 9mg) and then drop straight back to 1 or 2mg above where the flare happened. If that works - you're good to go and taper slowly again.

[ignatz]

I am currently coming down from a flare in mid January this year- so spread over 4 months!!!

Flared from 5mg, so went to 10mg.

Tried various reductions which did not control aches and fog.

Have now been operating a DSNS (Dead Slow Not Stopped) with 5/1, 4/1, old/new on a 39 day cycle- see the recommended steroidtaper.azurewebsites....

Now heading towards 8mg and wondering if 9mg is my minimum effective dose.....sigh....as I MAY be rather stressed by life's current travails.

Good luck with yours.

[PMRpro Ambassador in reply to ignatz]

YOUR dose is the lowest that leaves you as good as the starting dose did. Over time that IS likely to get lower but at times it sticks - and a flare wouldn't have been over by the time CV hit - and even if, like me, the stress is realtively minimal, it is still stress.