Have a question RE tapering. Understand going slow but not sure I get exactly how to do.

[Artwatercolour]

I had a flare so added 5 that took me to 15. Stayed there for a while then to 10. On 10 for almost a month but have pain in hands and arm. Does one persist or go back and add more pred? When tapering I know to give it some time to work but a month - it does not seem right?

[Sharitone]

You need someone more knowledgeable than me, but when one of the big guns comes along, it might help them to know whether painkillers have any effect.Also, are you saying that you dropped from 15mg to 10mg all in one go? If so, that is a very big drop; most people advise not dropping more than 10% of current dose at a time. Personally, I am gradually reducing from 15mg to 10mg at the rate of 1mg per month.

[Artwatercolour in reply to Sharitone]

Pain killers do not help. When I had the flare I added 5 gms which totalled 15 and stayed there for 7 days then dropped back to 10 - this has not helped.

[Mary63]

I think that 10mg was too low a dose for you when you increased to 15mg. So to go back down again to 10mg was unlikely to work. The usual advice is to go back to the dose at which you last felt good. Was that 11mg? Or 12.5mg? That might work, or if the inflammation has built up a bit too much you may need to do a few days at 15mg again, and then drop back down to the dose which last worked well.

[Hidden in reply to Mary63]

IMHO yes ten to 15 and then back to ten is not a good idea.

After a flare say at 10 go back to 10.5 or if necessary>11>11.5>12 etc.

If the flare recedes, hang around for a fortnight on the next working dose then drop by .05 for a couple of weeks eg11.5 two weeks >11mg,two weeks >10.5 and so on.

Remember it's not a race(that's an Aussie joke that our Prime Minister tells).

😁

[Artwatercolour in reply to Hidden]

Thanks for your reply I don't think I understood correctly - you have given me some clarity.

[Artwatercolour in reply to Mary63]

Thanks I will give it a try

[Mazxstitch]

Was at 2 had a flare went up to 7 for 10 days. Didn't know what was my last pain free dose so only dropped half a mg. 5 weeks on 6.5 feeling good! Will go to 6 in a couple of days.

[MrsNails]

Hi, have you tried a simple painkiller (eg Paracetamol) How long were you on the increased dose (15mg)

[Artwatercolour in reply to MrsNails]

Yes did not work

[PMRpro Ambassador]

I suspect your primary problem is you are trying to drop too much at one time. No reduction step should be more than 10% of the current dose although many do manage 2.5mg from 15 to 12.5 to 10 - but by no means all.

Slow tapering means not only allowing time between steps down but also making those steps down small so the body notices them less and also so you are less likely to miss the dose you are looking for. That ISN'T a taper relentlessly to zero, it is the lowest effective dose that manages the inflammation and symptoms as well as the starting dose did. PMR lasts a long time - one to 2 years is really the shortest you can hope for and it applies for about 1 in 5. The rest of us take a lot longer, 4 to 5 years to get off pred is probably the most common time and some of us take even longer.

[Artwatercolour]

Thanks for the reply - I understood when you have a flare to add 5 to what you are at and stay there till flare subsides then go back to where you were before the flare. Is this correct?

[HeronNS in reply to Artwatercolour]

Only if the dose you were on before was working. Often it's wise to stop the rapid taper a mg or two higher than you were before and taper again. It may not need to be a dead slow taper, but certainly slower than a drop overnight. It really depends why you flared. If you flared because of too rapid a taper then the return to the old dose should be a bit slower so you don't overshoot the mark. If you flared because the actual disease has flared, then a higher dose for a few weeks is called for and again, a slower taper.

To tell you the truth I have had a couple of flares and in no case was an overnight drop back to my old dose successful. I have been able in the past to step down rapidly over a few days. But this past year PMR really came back with a vengeance and a slower taper was necessary.

Always go by how you feel, not by rules!

[Artwatercolour]

Thanks for your response