When is a flare a flare?

[HamishPMR]

At what stage does one recognise a flare? Presently I am at 3.5 mg pred daily and whilst uncomfortable for a couple of hours each morning the 3.5mg seems to keep PMR symptoms in check. However the last couple of mornings, i.e. 4am the pain in my shoulders and neck has been dreadful to the extent I have taken 5mg this morning. I thought to continue on 5mg for three days then reduce. But is it a flare?

[DorsetLady PMRGCAuk volunteer]

This may help you understand…. healthunlocked.com/pmrgcauk...

Nub of the answer is usually whether increase of symptoms is immediately after a reduction (SW) - or further into the lower dose….and continues (F)….of course there may be another reasons…..too much activity, stress etc which may just give a blip for a few days and then resolve itself.

Never easy, is it?

[HamishPMR in reply to DorsetLady]

Along with PMRpro advice, so so useful. Thank you. Hamish Edinburgh.

[PMRpro Ambassador]

A flare is a return of symptoms due to increased inflammation because the dose of pred is no longer enough to contain it. It may be because you have reduced your dose slightly too far, below the lowest effective dose, or, less often, it can be because the disease activity has increased for some reason and so the dose you were on is no longer enough. Either way - it is a return of symptoms because the pred isn't enough to mop up all the inflammation each morning.

Pred cured nothing - it is a management strategy, PMR may increase because of stress - of any sort, physical, mental, environmental, chemical. Get stressed, especially at these low doses, and you also need a bit more pred to replace/supplement the adrenal function. No easy answer - just a balancing act.

[HamishPMR in reply to PMRpro]

Thank you, you are so helpful and I'm sure appreciated by all on this forum as well as myself. I'm 3.5 yrs into PMR and keep bouncing off that level so I guess I should put up with. Again, thanks. Hamish, Edinburgh.

[DorsetLady PMRGCAuk volunteer in reply to HamishPMR]

If you keep bouncing at same level, that probably tells you that you have reached lowest dose - at least for the moment. So go with the flow, and don't try and push below it. You will get there one day...and any dose below 5mg is no issue...Prof Dasgupta said in webinar that he sometimes keeps his patients at 2.5mg as long as required....

[PMRpro Ambassador in reply to HamishPMR]

What DL already said - you've arrived and Prof D wouldn't argue either.