Correct Dose for a Prednisolone Trial and How soon See Improvement if it works

[GreyBike]

I have (eventually!) been started on a 2 week trial of prednisolone by my GP (to try and determine whether I have Polymyalgia or Rhumatoid Arthritis or something else).

I have been taking 15mg for 3 days.

Is anybody able to advise whether 15mg is a high enough dose and how soon I should be feeling some improvement? (I weigh about 8 stone).

Am a bit concerned that I don't have any improvement yet.

Thanks

[DorsetLady PMRGCAuk volunteer]

Hi,

15mg is normal starting dose for PMR, and although some do get a miraculous result with a few days, I think you do need to give it a bit longer.

You’ve been given 2 weeks of medication - hopefully you should see a signification difference by then, if not then either it’s not PMR or it’s not enough medication. Whichever way, you then need to are-evaluate.

But you do need to remember, the steroids are only addressing the inflammation aspect of your illness, so

A. if that has had a long time building up, it may take longer to clear as well as controlling the new inflammation that occurs every day, and

B. your underlying Illness is not cured by the medication so you cannot carry on as if it is.

Just be patient.

[GreyBike in reply to DorsetLady]

Thanks for the reply. I am reassured that I am on the correct dose. I will try to be patient.

Unfortunately I have completely lost confidence in my GP and feel the need to check everything they do now.

[piglette in reply to GreyBike]

Good luck with the miracle improvement that should soon happen.

[PMRpro Ambassador]

I responded to 15mg in under 6 hours - some people do and there are others on the forum with similar experiences. Others need more and/or longer.

15mg has been the traditional "test" and starting dose for some years but current recommendations say the starting dose should be the lowest effective dose in the range 12.5 to 25mg. You aren't looking for an immediate 100% improvement - 75% in a few days is more usual. That may happen for someone with "just" PMR that isn't as a result of LVV (large vessel vasculitis). If LVV is involved then it it may well take more and longer. It also depends a bit on whether you have a lot of bursitis - it can take longer to fade and the pain to go.

[GreyBike in reply to PMRpro]

Hi PMRpro

Many thanks for the reply. You are a lot more helpful then my GP surgery! I have really bad pain in my shoulders. So I am thinking perhaps I have bursitis in my shoulders. Do I need an ultrasound to determine that? Or do I just hope that the prednisolone eventually cures it? Should I be taking an NSAID as well?

Thanks

[DorsetLady PMRGCAuk volunteer in reply to GreyBike]

No NSAID with Pred.

Bursitis often comes alongside PMR - so that may need to be looked at idc but get the PMR under control first.

[PMRpro Ambassador in reply to GreyBike]

As DL says - be patient. I had bad hip bursitis and that took a while to calm down on 15mg but it did go.

Yes, u/s would identify shoulder bursitis - in fact, it will also distinguish between PMR and LORA (late onset RA) with polymyalgic onset.

ncbi.nlm.nih.gov/pmc/articl...

In fact, would probably be better then the trial by pred.