what is a flare up.

[Flosy]

hi,i just wondering when they say a flare up can someone please tell me what it is.i know I might sound a bit thick or something,but would like to know,thank you.

[DorsetLady PMRGCAuk volunteer]

My view of steroid withdrawal v flare -

Steroid withdrawal v flare

Steroid withdrawal (or body getting used to new lower dose) usually shows immediately new dose is taken - and lasts between 2-5 days. It varies from a general feeling of being off colour to a return of symptoms pre diagnosis. For some it can be eased by paracetamol.

A flare happens when you’ve gone the level of Pred your illness requires and can take anything from a couple of days up to 2 weeks to materialise- and (usually)the symptoms are similar to those pre diagnosis. Paracetamol will not help. The only thing that does is an increase in dose. Sometimes a return to previous dose is enough, but if it’s got too bad then it’s recommended to add 5mg to the dose you last felt alright - stay there for 5-10 days and then drop back down to just above the dose you flared. Stay there for 2-4 weeks to make sure all okay before you try and taper again.

[Telian]

Hi Flosys

A flare is a return of your symptoms for no apparent reason. Usually means you’re not on enough Prednisolone for your level of inflammation. Go back to the last dose you were on where you were pain free. Stay there until symptoms have completely settled before trying another reduction/taper and try a smaller reduction. You don’t say what dose you’re on or if you have GCA /PMR or when you were diagnosed - that would be helpful in advising you. There are pinned posts on reducing and others will be along with those specifics.

There are also withdrawal symptoms that are the same as a flare. It was one of the first things my Rheumie said to learn. I have GCA and PMR - 6 1/2 years. I’ve suffered withdrawals the whole way through.

Withdrawals come on on a day when you are reducing - they last for a few days then go. You can take paracetamol to ease the discomfort. If they don’t go then you’re not on a high enough dose for you.

The aim is to find a dose that is enough to treat your level of inflammation and differs from person to person. Always let your GP/Rheumie know what’s happening so you can manage it together.

[Flosy in reply to Telian]

hi,i was dignosed in febuary this.iwas on 15mg then reduced the 1st aug to 10mg.but have been having headaches not as bad as I was.i have gca.

[PMRpro Ambassador in reply to Flosy]

That is too big a drop at once - not more than 10% of the current dose is recommended. Wish rheumies would listen to the pred experts ...

[Telian in reply to Flosy]

If you have GCA 15mg isn’t enough. Along with too big a drop no wonder you have headache. A minimum of 40 mg is usually given for GCA. Some start much higher as I did and within 6 hours I felt great.

Do you have a Rheumatologist or is your GP managing it? GPSs’ do tend to manage PMR but you need to see a Rheumatologist for GCA if only to get the correct diagnosis then your GP can keep an eye on you.

Your eyesight is at risk if you don’t get the inflammation under control. If you get any kind of visual disturbance go straight to A&E. Go to your GP and tell him/her your struggling. Don’t take no for an answer.

Let us know how you get on.

Best wishes.

[PMRpro Ambassador]

Simply a return of symptoms because you are no longer on enough pred. It can be because you have reduced the dose too far or it can be because the underlying autoimmune disorder has increased even though the dose you are on hasn't changed.