Withdrawal or Flare

[PatB1948]

I reduced from 7.5mg Pred to 7mg 12 days ago and getting the PMR pain in my shoulders, hips, thighs and also headaches. How long should I wait before increasing as I am not sure if it's withdrawal symptoms or a flare. Any comments would be appreciated.

[DorsetLady PMRGCAuk volunteer]

This might help -

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 below the level of Pred your illness requires, and 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.

[PatB1948 in reply to DorsetLady]

Thank you DL. I'll go back up to 7.5mg and see if symptoms improve, if not I'll try an extra 5mg temporarily as you suggest.

[jimcarlow75 in reply to DorsetLady]

Hi, good to hear what advice you give to others (and myself) , fasinating .I just come down 1/2 mg every 2 wks and hope for the best.

This is only if I am feeling I can cope with it remembering that QOL is paramount. I don't know about the tapering thats spoken about, and when other drugs are mentioned I'm lost. Just seen my GP and chatted about QOL and life expectancy ect

He's a great listener and I was pleased to know he will monitor me while I self medicate, I will have a blood test every 6 weeks or so followed by by GP visit. Thats reasuring . Would still like to know more about tapering from you, is it so different from a straight drop.?

[DorsetLady PMRGCAuk volunteer in reply to jimcarlow75]

Yes...there are a few versions - but the general idea is to move from higher to lower dose over a number of weeks rather than an straight drop from one day to next. This is just one version - . healthunlocked.com/pmrgcauk...

[PMRpro Ambassador in reply to jimcarlow75]

And this is another:

healthunlocked.com/pmrgcauk...

[PatB1948 in reply to PMRpro]

Thank you for this DSNS reduction plan, I shall certainly give it a go but at 0.5mg reduction. As I am feeling much better this evening, I shall wait until Monday and see how I feel before starting. Kind Regards, Pat

[aladymo in reply to DorsetLady]

I think that answers the question to my post. Thanks DL

[PMRpro Ambassador]

Basically, as DL says, When did it start?

Did you drop straight from 7.5 to 7mg? Or did you use one of the slowed tapers? That might help too.

[PatB1948 in reply to PMRpro]

I have been reducing 0.5mg per month so yes I did go from 7.5 straight to 7mg. I am on Methrotrexate 20mg weekly injection since February 2020 and in that time have reduced from 12mg in the last 10 months. Do you think I should try the slow taper.

[DorsetLady PMRGCAuk volunteer in reply to PatB1948]

Worth giving it a go- See my my reply to jimcarrow75 above

[PMRpro Ambassador in reply to PatB1948]

At these doses you are also waiting for adrenal function to wake up - and the slower and more gradually you reduce the less uncomfortable that is likely to be too.