Fatigue relief with increased prednisone??

[Ozark]

I have been suffering from the deathly fatigue associated with PMR for some time now and have been slowly increasing my pred dose from 9 mg per day to12 mg per day starting this week. Even though this goes against what appears to be the consensus of this group that the fatigue operates independently of the prednisone dosage, my question is has *anyone* had any success in relieving the fatigue associated with PMR by "increasing" the prednisone dose?

[tangocharlie]

My fatigue and 'brain fog' have definitely decreased. It always did whenever I increased the Pred. But I'm wondering if it has also improved since doing a low carb, no sugar diet? It could be the sugar created inflammation which needed to be combated by the Pred?

[Ozark in reply to tangocharlie]

Thank you for the reply.

[piglette]

I have had deathly fatigue, I was too exhausted to put out my arm to use the TV zapper at one point. By putting the dose of pred up a bit has usually improved it a bit, but it did not go away. It has actually been worst when I dropped below 7mg when the adrenal glands started to complain.

[Ozark in reply to piglette]

Thank you. You are the second person so far to indicate that an increase in pred may be useful in combating the terrible fatigue accompanying this disease.

[PMRpro Ambassador]

It depends on the cause of the fatigue - and what most of us mean when we talk about the "DF" is the fatigue that appears as you get below about 7mg and adrenal function has to start up again. Since that is due to the lack of corticosteroid, increasing the dose will improve the fatigue then. At high doses, even the 15-20mg it is common to use at first in PMR, you have the Duracell Energiser bunny effect that steroids create in some people. That outweighs the fatigue of the autoimmune disease - but disappears as the dose reduces.

Why are you slowly increasing your dose? The idea is to start at a dose high enough to clear out the inflammation and then reduce the dose to find the lowest level you can manage with. Increasing the dose rarely works because the inflammation is steadily building up and the low doses of pred never achieve anything so you are always playing catchup. It often means you have to go to a higher dose to get an effect than if you had gone in hard from the start - and in the meantime you have been taking pred with no benefits to balance the downsides.

[Wraysbury]

I have definitely found a relief from the all encompassing fatigue when I’ve increased pred.