Possible flare up of PMR

[Roastcauli]

Having been diagnosed with PMR in September 2020 after having symptoms for over a year I was prescribed 15mg prednisolone by my GP. I have been reducing the dose since then with no problems but this week since reducing from 5mg to 4mg I have suddenly realised that what I thought was stiffness from running is possibly a flare up of PMR. The pain and stiffness is similar although not as bad as before I started the steroids but seems confined to the right hand side of my body from shoulder, arm, hip and thigh whereas I always thought PMR was bilateral. Does anyone have a similar experience or any advice? I was thinking of going back up to 5mg for a while.

[PMRpro Ambassador]

You are not reducing relentlessly to zero - you are looking for the lowest dose that gives the same symptom release as the starting dose did. It sounds as if you have arrive at your interim destination with 5mg - it doesn't mean you won't get lower just not yet. It isn't unusual for a flare to start on one side and then spread, the worst/weakest bits tend to attract PMR!

Just going back to 5mg may be enough if you are in quick enough - if not, I'd add 5mg more (i.e. 10mg) for a few days and then drop straight bac to 5mg. That is a recognised way of dealing with this sort of flare and as long as you are only at the higher dose for 7-10 days at most it doesn't need a taper.

[Roastcauli in reply to PMRpro]

Thanks for your advice very helpful. From reading others experiences I took 10mg yesterday so will continue with that for a few days and then go back to 5mg. It took me a few days to realise what it was as I have had no symptoms since being on prednisolone!

[PMRpro Ambassador in reply to Roastcauli]

And if that is the case - that is the way it should stay!!!!

[Orpheus82 in reply to Roastcauli]

I, too, have very one sided PMR. It started bilaterally in both hips, shoulders joined in later then hips improved and now it’s only in right shoulder. This has been over the period of almost 5 years. Like you, my early journey of reducing pred was relatively smooth and quick but you may well find that getting under 5mg takes a lot longer. It might be better to reduce by half a mg now and use the slow plan that you’ll find on here. I’ve hit a wall at 3.5mg but as PMRpro says it’s not a race even if your rheumatologist implies this. I had a recent flare just trying to reach 3mg so I’m happy to stick where I am for a while. From 5mg and under the side effects are not as significant and it’s better to feel comfortable and be able to exercise and reap the benefits of keeping weight and BP down and build bone. Hope you’re feeling more comfortable now.

[Roastcauli in reply to Orpheus82]

Thanks Orpheus82 I think I will take your advice and reduce by 0.5mg from now.