Possible flare help

[Clucket]

Back in June I managed i thought successfully to reduce to 11.25. However before my next decrease I managed to use my arm which is affected by spondylitis too much and though it was immediate I could feel it slowly get worse. I thought that it was just the overuse that was the problem so I carried on with a decrease to 10mg.

This did not go well and I started to get all sorts of random pains starting, ribs, si joints and worse neck problems. (I do daily neck exercises for the spondylitis. )

I went back up to 11.25 but things still didn't really settle . I tried again on a slow taper to decrease but just got the same problems again.

I went back up to 11.25 again. Then unexpectedly I spoke to a rheumatologist who said I should go up to 12.5 for a week to settle it before reducing to 11.5.

I have now been on 12.5 for a week and although my rib pain and si joint pain is better the heaviness amd ache of my neck is still there. Some of this may be the spondylitis but I feel the overall ache and heaviness is due to the pmr.

Now I don't know what to do. Should I stay for another week on 12.5 or will this not be enough to make a difference.?

I have just decreased my neck exercises by 1/4 in the hope that this will help but am not sure what to do next.

[jinasc]

Personally I would up it to 15mg for a couple of weeks and then come down by 1.5mg a week, see how that goes and drop again by 1.5mg till you get down back to where you were. I would also take a look at the tapering plans in the pinned section and choose which one you want to use from now on.

When you overuse an existing problem or just do too much, PMR pays you back unfortunately - so steady as she goes from now on.

[Clucket in reply to jinasc]

Do you think it is worth waiting another week at 12.5 to see if things improve further in the neck dept. ?

[jinasc in reply to Clucket]

When I read " Some of this may be the spondylitis but I feel the overall ache and heaviness is due to the pmr. "

My instinct was that if you felt that way, then your instinct is probably correct.

You, of course, could wait another week and see how it goes.

[PMRpro Ambassador]

Think the rheumy was on the right track but not decisive enough: adding 5mg to the dose where the flare occurred for up to 7 days and then dropping back to the dose ABOVE where the flare happened is better.

Have they ever checked to be sure the spondylitis isn't alkylosing spondylitis? Sometimes it isn't obvious until very late.

[Clucket in reply to PMRpro]

I had an mri done and it showed normal spondylitis.

[Clucket in reply to PMRpro]

Continuing on the reducing theme , what is the advice on reducing if the other problems like the spondylitis are having a worse episode. Waiting till it gets better could take months but does reducing the prednisolone whilst it is having a flare make It worse or take even longer? I struggle to understand what I should do in this situation.

[PMRpro Ambassador in reply to Clucket]

Difficult to say - I suppose it depends on the dose that eases the spondylitis pain. If it is low, it may have fewer adverse effects than other means of managing the pain like NSAIDs.