PMR flare up

[LThomas]

I've been on 8mg of prednisone for a couple of years. I do have flare ups that last awhile. My current flare up has been going on for two weeks. Any reccomendation on how much to increase my dosage to knock out the flare? I'm very hesitant because it's so hard to get back down again.

Thank you.

[DorsetLady PMRGCAuk volunteer]

What levels do you normally go back up to?.....and does that sort the problem. I noticed in your first post you were talking about going up to 30mg and that was queried...much too high for PMR.

Normal advice is 5mg ABOVE the last dose you felt good at - so if that was, say 10mg, then up to 15mg for 7-10 days and then back down to just above current dose.

Plus can you confirm you have been on 8mg for 2 years? Somewhere you said you’d been down as low as 5mg - so bit confused - are you yo/yoing up and down, and use 8mg as an average or what.

I know you were in 10mg for a year - so I’m a bit surprised that you seem to be having so many issues now. Is everybody 100% sure it’s only PMR - or do you have other issues that could be muddying the waters?

[LThomas in reply to DorsetLady]

I've been on 8 for several months, tried to go lower but could not maintain the lower dose so 8 seems to work most of the time. Stress affects my PMR and that's when I have a flare, typically I can mitigate with naproxen, it's not helping this time. I'm good at 8mg 80% of the time. I have not been diagnosed with anything else. Today I'm feeling a little better, but in case the flare remains I would like an opinion on how much to increase and the best way to get back down.

Thank you!

[PMRpro Ambassador in reply to LThomas]

Hmmm - naproxen helping does make me wonder about whether it is entirely PMR. It mostly doesn;t help PMR problems.

[DorsetLady PMRGCAuk volunteer in reply to LThomas]

Both PMRpro and I have given same advice as to what you should go up to, and where to drop back down to.

The issue is how to get from 15mg to 9mg - some can do it in one drop, others need 2 stages, maybe you need more! So 15-13-11-9 in weekly stages might work.

But you must remember PMR loves stress - unfortunately we can’t eliminate stress from our lives completely - so its learning how to manage it as best you can.

[PMRpro Ambassador]

I don't have much to add to DL's comments - except to ask whether these flares occur in response to having recently reduced the dose of pred? Or could they been in response to a change in circumstances causing more stress or activity?

Have you ever tried adding 5mg to the dose at which you flared for 7-10 days and then returning to slightly above that dose?

You do need to understand that the pred doesn't "knock out" a flare - pred provides symptom relief, it has no effect on the underlying autoimmune disorder.

[LThomas in reply to PMRpro]

Thanks to you both for your promt replys. You've answered my question about increasing my dosage, both of you seem to agree that I should try 5mg and once it is mitigated I could try coming back down in two or three steps.

Thank you both!

Larry