How fast does Prednisolone work?

[SFFo]

I've been on Prednisolone 20mg for a few weeks but haven't really noticed much improvement. Does this mean it's not going to work or am I expecting too much too soon?

[DorsetLady PMRGCAuk volunteer]

A few weeks in on 20mg one would expect a better result, but if you have other issues , or it’s been building up for a long time and there’s a lot of inflammation to get under control…you may need slightly more..

What has improved, and what hasn’t? Plus you do need to remember that Pred doesn’t actually cure the underlying (there is no cure as such) all it does it dampen down the inflammation caused by the illness…and the substances (cytokines) that cause that inflammation continue to be shed every day you have PMR.

So early days the Pred is working on the accumulated inflammation built up prior to diagnosis and the new daily addition.

You have a serious system illness, and need to treat yourself according, so slow down, give yourself some TLC, and see if that helps.

When are you seeing doctor again?

[Ambientman]

It worked for me within hours, felt great

[madhouse1 in reply to Ambientman]

Me too - amazing miracle.

[PMRpro Ambassador]

After "a few weeks" you should be seeing a distinct improvement if the dose is enough for you. The next step should be to try 25mg (the 2015 Recommendations say the lowest effective dose in the range 12.5-25mg). If that doesn't improve things - you should be looking for a 70% global improvement in symptoms - the doctor should be thinking about whether this really is PMR or something else that looks like PMR. By global improvement that doesn't necessarily mean everything - your stiffness and much of the muscle pain may be gone but any bursitis may take much longer to go.

But the other question is as to whether YOU are doing YOUR part in managing the symptoms. Are you avoiding activities that make the symptoms worse? Resting appropriately? Being on pred is not a licence to go back to normal life and heavy activity - the actual underlying disorder that causes the inflammation and, hence, the symptoms, is still active, attacking your body tissues and leaving you in a similar state to if you had real flu. Your muscles are delicate as a result and intolerant of acute exercise. And that includes gardening or housework. Do too much and you are likely to develop DOMS (delayed onset muscle soreness) without doing the usual sort of level of exercise/activity you are used to. It will be worse than you are used to and will take longer to resolve. If you haven't recovered before you try more activity, you may never recover enough to be pain-free.

[Lovetobe in reply to PMRpro]

Hi PMRpro reading your reply, that seems to be ringing true with myself.q I'm desperately trying to read through some posts and actually understand the illness. I've been struggling since March with the onset of the arm pain and impingement but because I have fibro my doctor wouldn't believe me that" this" was different. My imflamation markers were all normal. Eventually it reached my legs /hips I was having horrendous nights, but still no help from doc, till eventually end July my crp was sky hight and esr just above the limit. Then it was oh it might be PMR.Started 15mg steroid 3 weeks ago, after a week imflamation down, leg knee hip better spine stiffness gone, just arm pain, and lack of movement. Doc said that should of seen more improvement as like others it may be atypical al and not pmr. So 3 weeks on I can now wash my hair ! But because I have felt better have done more, gardening housework, and I've no more improvement in arm pain. Just wondering is it pmr and I'm not helping myself. I'm beginning to realise I'm not going to do what I used to, I was very active, even with my fibro.

Have bloods again tomorrow so will see results and what doc suggests I guess. I just feel I need so much more guidance in what the actual illness is etc .

Gosh sorry what a ramble!

[PMRpro Ambassador in reply to Lovetobe]

Is this the GP or a rheumatologist? The 2015 guidelines give the starting dose as "the lowest effective dose in the range 12.5-25mg" - so 15mg is towards the bottom end of the range. Many have this fixation with "atypical" - in fact they will tell so many patients with PMR that they are atypical that you are left to wonder what is typical when what those patients are describing what so many of us have experienced.

You can have impingement along with the PMR. You can have myofascial pain syndrome as well as PMR, it can be part of PMR although it also happens in isolation. Neither will show dramatic responses to pred.

But above all, you have to give it the best chance: being on pred isn't a licence to go back to normal but so many people do just that and wonder why it doesn't get better quicker.

[Lovetobe in reply to PMRpro]

Hiya, the Gp following the NHS guidelines. If after bloods tomorrow (3 weeks) imflamtion is down again but my airs are still painful and not moving properly she said she would refer to rheumatologist, but I guess there are good and bad ones that know pmr better than others, I have ultrasound on my arms shoulders and it shows no bursitis etc.

[DorsetLady PMRGCAuk volunteer in reply to Lovetobe]

Maybe have a read through this, gives a patient's view of PMR/GCA -slightly different to what doctors think...and then maybe wander through the FAQs

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

[Lovetobe in reply to DorsetLady]

Thankyou I will have a read

[piglette]

It may be worth trying 25mg, but it possibly points to the fact that you do not have PMR. There are other things with similar symptoms such as fibromyalgia and even vitamin D deficiency for which steroids would not work. Have they been considered?

[USAGCA in reply to piglette]

Agree. PMR symptoms should improve within hours. Check the diagnosis.

[PMRpro Ambassador in reply to USAGCA]

Not necessarily at all - it can take a few days. If you let some doctors think it works in hours, they will decide it isn't PMR after all ...

[Ana-16]

I hesitate to write here because I’m relatively new to this but this has been my experience. I was prescribed 15 mg to start with having been in severe pain for some weeks. I took the first dose in the evening and woke up relatively pain free. I was then advised to take the medication in the morning with food. This did not work for me at all snd the dose was put up to 20 mg. Again this made little difference. Having read some of the posts here I decided to try splitting the dose. The effect was immediate. My GP and rheumatologist (whom I met for the first time this week….. more about that encounter anon) were both happy for me to continue with this pattern. I am now reducing but still splitting the dose. I hope this may be useful. Best wishes

[SheffieldJane]

Oh poor you. You are in that horrible no man’s land of no definite diagnosis. I would have thought that your pain would be better and you would be feeling more flexible by now if it was PMR. Maybe you have a number of co- morbidities that won’t allow proper relief. Take advice, but you certainly don’t want to be taking steroids unnecessarily.

[LBM1953]

Hi. This was my experience. Diagnosed end of May and started on 15 mg - no help at all. Then 20 mg - some relief. 25 mg and bingo - most of symptoms ameliorated. Doc was very reluctant to go beyond 20 mg initially but after consulting someone came back and wasuch more amenable to increasing the dose. Doc then put me on 30 mg hoping that ALL symptoms would disappear but still same (minor shoulder discomfort at times. Steroid side effects aren't great but better then the PMR symptoms.. Down to 22.5 mg as if today and hoping to get to 15 mg by mid October and then use the DSNS plan.

[Viv54]

On my first round of pred my Dr gave me the tablets in the morning and she rang that evening to ask if they had worked, it was like a miracle , all pain gone. But on my next round of pred it took ages to work and was not as effective , This time round it kept things at bay.

[Roy46]

I started pred at 50mgs and within an hour all the pain had gone. Miraculous cure! No. That was 7 years ago and I’m still on the journey.

[Roy46]

Within an hour of taking my first pred at 50mgs all pain had gone. Miracle cure! No. Seven years down the road I’m still on the treadmill.

[cycli]

sorry to hear that but keep hopeful. Presumably you are on a low dose now.

[tytto]

I wa s Amazingly Better within 48 (even less) -- Pred was a miracle cure -- no pain, stiffness lessened, slept great!! Not so great now after tapered to 5 mg within 2 years -- back up to 7-8 mg and amdoing quite well at age 85. No pain, moderate stiffness though not every day. No problems with Pred- cataracts removed prior to PMR,

knees replaced 8+ years ago, no diabetes, (slightly elevated glucose level) still sleep well etc.

Good luck on this road of dealing with PMR - probably a long road!