Tapering

[Bridgegoddess]

started out at 30 mg per day for my PMR in late Feb

I got down below 20 mg and my Rheumatologist wanted me to reduce by 2.5 mg at a time I got to

10 mg and had a flare or sensitivity

She wanted me to Go to 13 mg for 1 month then 9 for a month I knew there was no way for me to go

13 down to 9 at once However it turned out even 13 did not work After

4 days of trying I went to 15 on my own That worked,so I used an adaptation of your dead slow method

It worked nicely until I got between

11 and 10 again Shoulder stiffness and some pain returned I guess

11 is my nemesis

So after 3 days back to

15 A bit slower to work but after my 10 ( I use a split dose) in the AM it goes away I am really anxious to get below 10

So I wonder if going from

15 to 12.5 at once is going to work

Since the 11-10 appears to be a trigger point , I wonder if it will work to stay at 12.5 longer ,and then back to a really dead slow will help

I have been back at

15 for 5 days

I hate to keep up the yo-yo back to 15 but would like to get back down We have a had a recent surge in Covid cases here in B.C. Canada and I know I am somewhat safer under 10 mg per day Thanks for any advice

Bridgegoddess

[DorsetLady PMRGCAuk volunteer]

Have copied my reply to you in other post - for others info as well -

I can understand you want to get below 10mg - but to be honest there is no point if your illness needs more. You will only end up with a flare, and the more often you flare, the more difficult each resulting taper becomes.

Personally with your previous issues I would only reduce by 1mg a time - it’s much more in line with the recommendation of not reducing more than 10% of your existing dose.

As you were only diagnosed in February - your PMR has a lot longer to run ( despite what you may want or your Rheumy may think).

[PMRpro Ambassador]

This is what I wrote where you first asked the question - just for completeness:

"Forcing to get below 10mg is only going to result in a flare which will send you back higher to get it under control. Each time you do that is likely to make the next reduction harder. However slowly you try to reduce nothing will get you below the objective: the lowest dose that gives the same result as the starting dose did. 10mg and unhappy has no benefit re Covid - you have no natural immunity, no-one does and you can't alter the history of your pred dose. The adrenal component is as significant as whether you might possibly catch it more easily because of pred. And if you were to catch Covid then probaly the first thing the doctors would do is increase your pred dose. Not least because the knowledge now shows that pred helps in the fight against Covid.

You are at the start of this journey - half of patients remain on pred even after 6 years, only a third are able to get off pred in 2 years. ...

... it doesn't mean you won't get lower - just not yet. There is no point fighting it - if 11mg is "your" dose for now, be grateful. Try another 1/2-1mg in a couple of months. Often having a bit of a rest from reducing helps."

[Bridgegoddess in reply to PMRpro]

We are just getting the protocols for Pfizer vaccine roll out in our Province in Can It was mentioned that

The second stage of the roll out will be

80 plus age group, which is where I fall But they said the Pfizer vaccine was not appropriate for anyone that is immune Compromised Of course prednisone will compromise ones immune system, but as you reduce the effect is less and less I am currently at 11.5 a day and going to 11 in the next few days My question is what had happened in Britain with the vaccination program and those with PMR who are shielding

What dose of prednisone is needed to effectively reduce the immune compromised situation so that the Pfizer vaccine would be okay to used

Thanks Myrna

[PMRpro Ambassador in reply to Bridgegoddess]

The immunocompromise they are talking about is patients who have cancer, have had solid organ transplants, are on certain immunosuppressant drugs such as JAK inhibitors and certain biologics and some other similar groups. It is not the patient on under 20mg pred - probably not the patients on above 20mg pred only.

For patients on pred or other similar drugs the question is how much their immune system will respond - but that is also the case for patients receiving the flu vaccine and it seems to work for most of us. Even a small bit of practice at what to do when it meets the Covid virus will benefit the immune system in the event of it happening.

[Bridgegoddess in reply to PMRpro]

Thanks so much The information is very helpful