This post was written in response to a post from someone who was struggling with working (self-employed) after her diagnosis of PMR and being faced with both increasing pain as she reduced her pred dose but also demands from her doctor to reduce that dose as she is diabetic. There are doctors and family members out there who believe that "you're on steroids, you must be back to normal now". I'm afraid the answer to that is a resounding NO!!
"Please don't class me as a misery guts, party pooper or doom-laden moaning Minny - but you are not in 100% blooming health. You have a chronic illness, due to an underlying autoimmune malfunction which means your immune system is attacking your body by mistake. The autoimmune disease has not gone away because you are taking steroids, all the steroids have done is act on the inflammation that is caused by the autoimmune activity and which causes swelling. This swelling causes pressure on various bits of your body including nerves and muscle cells and this makes you stiff and causes pain.
There are various stages of recovering from PMR - and the first of them is to get the inflammation under control as completely as possible. Once you have achieved that - and by no means everyone gets 100% relief - you can start on the longish process of reducing the dose to the minimum needed to manage the inflammation. And managing the inflammation is ALL you can do until the underlying autoimmune part of your illness dies away and goes into remission. There is no cure for it at present - just as there is as yet no cure for rheumatoid arthritis, lupus, autoimmune thyroid disease and MS and the other members of the same family.
It is well documented, and most people come to realise on their own, that more stress makes the symptoms of autoimmune disease worse - for various reasons. Overdoing exercise will almost always make sore muscles and joints more uncomfortable - much of the problem is when the blood supply isn't enough to provide the oxygen needed for activity which is why we get tired when we try to go faster than we are really able. There is a fair amount of both pysical and mental stress in fitting in a timetable like you describe - and any such stress can mess with your immune system. That's part of the reason you tend to get infections when you are overdoing it. And we are doubly at risk as our immune system is trying to work overtime making us ill AND we are taking steroids which damp down that immune system to try to make the effects of the malfunction less extreme on our bodies so we can live a reasonably normal life.
If your doctor had told you that you have some other illness or if you had broken a leg you would have taken the time to allow for recovery. I know all the arguments on the part of the self-employed - I'm a freelance translator, if I don't work, I don't earn. But I also don't have a mega-physical component to my job nor do I have to get up, get dressed and get to work - although before steroids I had terrible hand pain that made typing difficult, back pain and leg stiffness that made getting up from the desk interesting and brain fog on occasions that made turning German into English quite an adventure .
The balance you have to look at is one of the amount of pred you take and the quality of life/amount of work you achieve. If you take more pred you can probably do more - but you are also exposing yourself to the risk of increased side-effects from the pred. And that is the thing you have to look at very objectively yourself and also discuss it with your doctors. You have the diabetes and BP cards - both not helped by the pred. Diabetes itself is often an autoimmune problem so stress won't help it either and BP is also not helped by overdoing things, physically or mentally - although exercise of the right sort can improve both diabetes and BP problems dramatically. But there is a very good reason for you needing to be in a lower dose of pred.
At the moment, if it were me, I would go back to the 12.5mg and once the pain etc has settled, start to reduce but by not more than 1mg at a time. But you also have do your part in the management of your disease. You have to learn to accept that you cannot carry on at full tilt and expect to feel fine. It's called "managing" for a reason - and both the doctor and the patient are partners in the management team.
It is hard - I know. Most of us here who have had PMR for a long time have had to give up something that was very precious to us. But you don't have to give up everything - and you find other ways to do things and other gifts. That is also part of the PMR and GCA journey.
This
healthunlocked.com/pmrgcauk......
has links to helpful articles that also help get your head around it all.
PMR or psoriatic arthritis 
In the aftermath of PMR
Question regarding the cause of PMR
Advice on PMR for lawyer
Pmr/gca or myosthinia gravis? 
