New and unsure of PMR journey 🤔

[Pangolin43]

Good morning everyone,

Quick question. I’ve tapered from 15mg (1 month) to 12.5 (in 2nd week). When I wake up I feel my symptoms are resurfacing but after a couple of hours I feel better having taken Pred. Is this the usual pattern? Do people generally have symptoms first thing on waking and is this something we just have to live with. Or should I feel less achy? My rheumatologist has asked me to reduce to 10mg and I’m wondering if I should go back to 15mg for a while.

I would appreciate the experts view on this brilliant forum.

Thank you in advance 😀

[PMRpro Ambassador]

It is normal to feel any symptoms early mornings: the inflammatory substances that cause the inflammation are shed in the body at about 4-4,30am. They start creating inflammation again so the sooner after that you take the pred, the less it has to do and the sooner you will feel less uncomfortable. The ideal time to take pred to avoid morning problems is 2am - it reaches its peak in the blood by 4am so the inflammation never gets a hold and mornings are much better - but the symptoms MAY reappear in the evening instead.

For many people the effect of pred lasts the full 24 hours or more but it can range from 12-36 hours and if you are at the lower end, the effect wears off before the next dose is due. If it is really a lot less than 24 hours, splitting the dose may deal with that. You would take about 2/3 of the dose in the morning and the rest later enough in the day to extend the effect to the next morning's dose., just at lunchtime may be enough, it doesn't have to be before bed.

When does he want you to drop the dose again? He seems in an awful hurry ...

[Pangolin43 in reply to PMRpro]

Thank you for your reply. I have my second COVID-19 jab tomorrow and she asked me to drop my dose immediately to 10mg this is t gain greater efficacy from vaccination. However I’ve only been on 12.5mg for 2 weeks and find this thought a bit scary!

[PMRpro Ambassador in reply to Pangolin43]

"this is t gain greater efficacy from vaccination"

Which may well be counteracted by the less well controlled inflammation returning! Fine in theory - I couldn't have done it.

[Pangolin43 in reply to PMRpro]

Yes. Me neither. Have spoken to her and I will stay o 12.5mg for the next two weeks and then reduce to 10mg. I have cancelled vaccination tomorrow and will rebook in 4 weeks approx. Hopefully be vaccinated on 10mg which I will stay on for two months. Fingers crossed!!!

[PMRpro Ambassador in reply to Pangolin43]

Indeed - hope you get there OK! I've had both mine at 15mg - no other option ...