What would be a good Prednisolone restarting dose ?

[Louisnhoe]

I have been off Prednisolone for 7 months now after 16 months of a slow taper since Feb 2020. Symptoms restarted shortly after stopping and I have a blood test and follow up phone call with my GP next week.Restarting steroids is undoubtedly the way forward. Does anyone have any ideas as to what dose would be reasonable to start with.? I suspect my GP will advise higher than I would like.! Thoughts would be very much appreciated. Many thanks for any input.

[PMRpro Ambassador]

What you need to get the symptoms under control. If you had jumped in as soon as the symptoms reappeared you would almost certainly have got away with under 5mg, possibly even just a couple of mg.

Although with the start of PMR I wouldn't try this: if it were me I'd try 5mg first and see what it does. I think it it is reasonable to assume that the reason it is now bad is because the very low level of disease activity has finally filled the bucket so there is probably not a high level of daily inflammation to counteract. But it took 6 months to get to this stage, it must be pretty low.

[Louisnhoe in reply to PMRpro]

Thank you PMR Pro for your very quick response. Hopefully you are right and disease level is low. My symptoms are not as bad as prediagnosis but there nonetheless.I had been hoping that some of the symptoms which are mainly pain and stiffness at the backs of both knees were me getting over the steroid use.But no, it's been too long now. Will see what GP says and would be happy to restart at 5mg and see how it goes.It' s a big learning curve and I'm so glad I joined this forum. Will let you know how it goes.

[PMRrunner in reply to Louisnhoe]

My rheumatologist was very reluctant to let me restart taking prednisolone when symptoms reappeared but eventually agreed and 5mg has been enough.

[Louisnhoe in reply to PMRrunner]

Thank you for your reply PMRunner.I am hoping my GP will agree. If so how long should I stay on 5mg before starting DSNS method of reducing ? I feel that this might be a good plan as PMR activity is likely quite low.

[PMRpro Ambassador in reply to Louisnhoe]

Until you are confident the symptoms are under control - a couple of weeks at least though.

[Louisnhoe in reply to PMRpro]

Thank you.Hopefully my GP will be open to thoughts on this.Just want to get on with it now and start to feel better.

[PMRrunner]

I'm staying on 5mg at least until I see the rheumatology nurse in April so I'll have been on 5mg for nearly 5 months. I feel so well I do feel I could probably start reducing the dose very slowly but being very cautious this time no matter what the rheumatologist/rheumatology nurse say! Good luck, hope 5mg works for you

[Louisnhoe in reply to PMRrunner]

Thank you. Hoping we can put the plan in place. Glad you are feeling well now and yes I guess it makes you reluctant to change what's working. It's a horrible condition and we learn as we go. Such a comfort to have support from this forum. Bloods on Monday and GP phone call Thursday next week.Will report back.!

[Cazdud]

Hi I guess it depends what dose you were on when you started. I would start on 5 mg for a couple of days and see how it goes.

[Louisnhoe in reply to Cazdud]

Hi and thanks for that. I started on 15mg and followed GP instructions of 1mg reduction every 6 weeks. I probably should have stayed at 2 or 3 for a bit longer than I did . Will do things differently this time if GP agrees.