Reducing prednisolone

[Juliey43]

Hi I have recently been diagnosd with PMR. My consultant wants me to reduce pred from 12.5 mg to 10 mg - is that too big a jump? I have read on the forum 10% reduction is better. Also if you work in a busy environment and are on 12.5 mg pred is that potentially dangerous due to immune system being suppressed in terms of Covid?

[DorsetLady PMRGCAuk volunteer]

Hi,

Some can manage it, some cannot! Plus if you are working it might make it more difficult.

As for 1mg tablets anyway, you will need them. In the meantime you can cut your 2,5mgs to give 1,25mg - Near enough.

Is your employment aware of your PMR - and making provision to accommodate your illness? Your line manager, work colleagues and HR need to be aware.

Being on Pred doesn't necessarily make you more prone to getting COVID, but it makes it more difficult to recover from it....and the higher doses and length of time impact on that.

This is some info put out by one hospital trust -

cuh.nhs.uk/sites/default/fi...

There are plenty of posts on this subject. Type in coronavirus or COVID into search box for more info

[Juliey43 in reply to DorsetLady]

Thank you - have informed employer but it is teaching and all teachers are expected to return. There is no online learning from Sept.

[DorsetLady PMRGCAuk volunteer in reply to Juliey43]

Okay. Well you are going be under pressure then - so I would suggest you taper as slowly as possible - and hope that your school has all the covid -19 measure in place.

Good luck.

[PMRpro Ambassador]

12.5 to 10mg is a common reduction step and if it works that is fine - you will know if it doesn't! And then you can go back and the 10% rule can be introduced for the next time. From 10mg each drop should be not more than 1mg anyway.

You might find the video Leeds produced for patients helps you assess your risk:

healthunlocked.com/pmrgcauk...

The general concensus is that 10mg/day and under is safer than being above that - and the situation now is much less risky than when the original information was being given out. I'm not sure that immune suppression by low dose pred is that sigificant - no-one has any resistance to the virus anyway.

I think it will depend what you do and what mitigating measures your employer has introduced as a whole.

[Juliey43 in reply to PMRpro]

Thank you for your advice.

[Saxsoprano]

Hi Julie43. When I recently had a flare of my GCA (February ) my rheumatologist put my pred up to 15 as an emergency measure (I had been down to 3 1/2 before the flare) . However he agreed that after two weeks I could reduce directly to 10mg and then continue with a 1mg reduction every two weeks. However , having taken 10 mg for two weeks I continued by following the advice here and reducing by 1/2 mg every two weeks and doing this with the slow tapering protocol. I'm now back down to 4 1/2. This works for me but I am not working so when tired can rest as much as I need.

[Marilyn1959]

Hi Juliey43. You are entitled to ask your Headteacher (or designated responsible person) to complete an individualised risk assessment with you. The limitations of PMR and unpredictable nature of the illness merits this, aside from the exacerbations of COVID. The meeting would enable you opportunity to inform on the impact that PMR has on your ability to undertake and perform in your role. Together you can agree management controls that could help to reduce the risks for you. I.e. to be released from the responsibility of playground duty since the muscles in your legs are adversely affected doing this task. Since fatigue is a major symptom ensure you leave work by 5pm each evening. Complete all marking before leaving at 5pm, so that you are not carrying heavy books to and from work to home and that you are able to rest since deathly fatigue is already symptomatic of this condition etc COVID can be included, however there may already be a school wide ' vulnerable staff' COVID risk assessment. Re the PMR you are also entitled to be referred to a workplace occupational therapist, who could also advise additional control measures that may be helpful, such as ensuring adequate seating in the classroom. It may be a reduced timetable could be agreed? Risk assessments are a great tool for focussing the mind, reducing barriers, providing clarity for all concerned.

[Juliey43 in reply to Marilyn1959]

Thank you Marilyn some great advice. I will be speaking to them about my diagnosis and how it can be best managed at work. I feel absolutely fine now I am on the pred but sure the fatigue will kick in once I return in September.

[Juliey43]

Re: the last comment I meant I feel fine - rested - as currently off work.

[PMRpro Ambassador in reply to Juliey43]

Exactly - not the same thing at all!