Does prednisone help or cause the extreme tiredness.

[Renesch]

I was recently diagnosed with Polymyalgia after months of trying to find what was wrong with me. Changing doctors did it. I was suffering from more and more Debilitating pain until I finally reached into a bottle of prednisone I had had 6 years prior for bronchitis and took one. It was a miracle. I woke up almost 100%. Saw new doctor and received diagnosis that day. Now 2 weeks later no pain but by early afternoon I am so tired I can barely function. It is the Polymyalgia or the drugs, I never felt tied before just had the upper leg, back, shoulder and arm pain. Any ideas.

[PMRpro Ambassador]

Fatigue is a component of almost all autoimmune disease. For some people it is a side effect of pred. For others it is a douoble whammy. But unless the pred causes you the Duracell Energiser Bunny effect it rarely combats the fatigue.

There are two possible answers: the fatigue now is the pred. Ot you are feeling so much better that you went back to normal duties and that is creating the fatigue. The pred only combats the inflammation, it does nothing to the a/i disorder which continues in the background and creates a feeling much like flu. Would you be surprised at feeling like this if you had proper flu? PMR is a fairly severe systemic illness - not just sore muscles.

Managing the fatigue is up to you - pacing and resting, resting before you crash often creates more good hours in the day. You learn to adjust your lifestyle to avoid waking the gorilla:

healthunlocked.com/pmrgcauk......

[SnazzyD]

A bit of both. Fantastic you have got some relief. The autoimmune condition is not stopped by Pred which is just there to combat the inflammation produced and reduce pain. Therefore, the fatigue of active disease (sounds awful I know) will still be apparent until things calm down which can be quite a while . Pred can also cause a bit of the weak wobblies as well as insomnia. So, rest, rest and more rest is what you need. I lived on naps. It will get better.

[Daffodilia]

Try to take a nap during the day for tiredness and pace exercise

[Louisa1840]

My post-lunch nap is a MUST and my brother (who also has PMR) does one after breakfast as well. Learn to factor it into your day if you can.......

[Moness]

Agree with all the comments about resting, I lie down on the floor after lunch as the hard surface seems quite comforting! The fatigue makes you feel ancient at times but having this during lockdown has been easier somehow as we can’t keep up the pace of our former lifestyle. Am really looking forward to getting back to swimming but it will be in the slow lane.

[Renesch]

Thank you everyone. I cut the dose off prednisone back from 20 to 10 and felt so much better today. Now convinced it is the drug. Pain still reasonably under control, would prefer some pain and more energy than the unbearable fatigue. See doc on Tues so will get better advice as original diagnosis was made at an urgent appointment as we were leaving to go on holiday.

[PMRpro Ambassador in reply to Renesch]

Beware - if you have some residual pain then it may be that there is an excess of inflammation compared to the current dose. It will build up and you do run the risk of returning to state you were in pre-pred.

[Kendrew]

Don't forget Renesch that a drop in dosage can cause 'muscle and joint pain' withdrawal symptoms. Three times now after reducing dose, I've developed PMR symptoms that have then disappeared again after 7-10 days. Hard to determine though whether pain is due to that or PMR returning and I acted only on advice of my rheumatologist.

[PMRpro Ambassador in reply to Kendrew]

Pain that starts immediately after the dose is changed is almost always "steroid withdrawal rheumatism" - it can be minimised by making the change as small as possible and should resolve over the following week or so.

Pain that doesn't appear for a few days is more likely to be because the pred dose is now too (though not always) and a flare is threatening as the inflammation builds up. The pain and other symptoms then progressively get worse unless you bale out and go back to the previous dose. The longer it is left the more difficult it becomes to get under control. It is a good idea not to let a flare get hold because then you can easily get into a yoyo pattern with the dose and over time it gets harder to reduce again.

[Kendrew in reply to PMRpro]

I think as we're all discovering, there are no certainties with this condition....just generalisations, and many 'exceptions to the rule'! I would appear to be one of those here as I have not developed what was clearly withdrawal symptoms till 3-4 wks after the past 3 dose reductions. My rheumatologist advised me that when reducing at lower doses, it will take the body longer to react to the reduction because the change in dose is minimal and the body takes longer to recognise that change. As you said though, it's important to determine what is withdrawal and what is the re-emergence of PMR.....which is why I take my lead from Professor Dasgupta.

[Renesch in reply to PMRpro]

Thank you most helpful. Yes had much better day on 10mg and I slept which has been a problem with prednisone. That was till 5am then in such pain again. Will go back to 20mg and only reduce slowly with doc advice. I guess my gym strength class and walking groups might not see so much of me for a bit.

[PMRpro Ambassador in reply to Renesch]

Maybe 15mg - and 10mg in the morning and the other 5 mg later in the day. That might solve the early morning pain.

[Fergyfish]

I cant add much to all of the above, except that these ladies know what theyre talking about! And I took a long time to get my head round what pacing myself really meant! When you do it really helps!

[ignatz]

Excellent. I had not realised that fatigue was NOT controlled by steroids- and now in 3rd year of treatment. Back to napping on the sofa!