Advice

[Tilian]

Hi, I had to get my Pred increased to 20mg as 15mg wasn’t doing the job, I have noticed a difference, I am very stiff and sore in arms and hips in a morning but wears off after 3-4 hours after taking Pred, is this normal in a morning or should I be getting longer relief than that

Tilian

[DorsetLady PMRGCAuk volunteer]

Hi,

How long have you been on 20mg, if only for a few days, might take a bit longer to get a better response.

What type of Pred are you taking, the plain white uncoated tablets or the coloured gastro resistance ones…and what time?

If the former, they take an hour or so to get into system, the latter longer…so perhaps you could tablets a bit earlier.

My instinct would be, that as you were only recently diagnosed, you need to give the higher dose a longer to work….it doesn’t always give an instant response in everyone.

[Tilian in reply to DorsetLady]

Hi, I have just been on the 20mg since Friday, I was changed to the soluble ones on Monday as I have other medical issue in which I can’t absorb the same,so hoping they might work better, I am obviously looking for miracles to happen, I just need to be more patient

[DorsetLady PMRGCAuk volunteer in reply to Tilian]

Yes probably to patience 😊

[Tilian in reply to DorsetLady]

Hi, went back to my Doctor after being more than a week on 20mg Pred and still not making much difference, I have really sore shoulders, some mornings I can hardly move my arms, Doctor suggested splitting my dose, I have been doing this for 3 days now, the difference is amazing, waking up in the morning almost pain free( except for my usual old age aches and pains)I hope this is going to continue and not just false hope for meTilian

[DorsetLady PMRGCAuk volunteer in reply to Tilian]

Good - as you say, let’s hope it continues. No reason why it shouldn’t.

[PMRpro Ambassador]

The new daily batch of inflammatory substances is shed in the body about 4-4.30am and starts creating inflammation in tissues, causing the symptoms. The antiinflammatory effect of pred lasts 12-36 hours depending on the person. If you are lucky and an over-24 hours person, it will still have an effect so mornings won't be too bad. OTOH, if you are a less than 24 hours person, unless you take your pred early enough, soon after 2am is ideal, there will be some inflammation. The later you take your daily dose of pred, the more inflammation has been created, the more the pred has to do, the longer it takes. Plain prednisolone takes an hour or so to get into the system, prednisone takes longer as it must be processed by the liver. If you have absorption problems that adds to it.

If the problem is it doesn't last the full 24 hours, maybe splitting the dose would help - but that is something to look at later. There is also the option of depotmedrol injections if you have aborption problems - it is then directly into the system,

[Tilian]

Hi, I haven’t posted on here for a while as I have been feeling quite good, started February on 15mg Pred but that dose wasn’t helping much, Dr increased me to 20mg which made a huge difference, after a couple of months was told to change to 15mg again, I was coping ok with this then after a few weeks had to go down to 12.5mg, I started feeling a bit stiff in arms but not too bad, after Rheumatology appointment I was told to go down to 10mg I have been on that dose for 4 weeks and gradually all symptoms are back again, I feel I am back to square one, should I increase my dose again and if so by how much

[DorsetLady PMRGCAuk volunteer in reply to Tilian]

This link is usual advice for a flare -so I would say 15mg for7-10days -then reduce by 1mg. If you haven’t got 1mg tabs then so long as 2.5.mg are plain white tabs cut them in half. Stay on each dose 3-4 weeks.You will need 1mg tabs once you get below 10mg so request them.

healthunlocked.com/pmrgcauk...

[Tilian in reply to DorsetLady]

Thanks for your reply

[PMRpro Ambassador in reply to Tilian]

You need to discuss this with a doctor - that is a standard reduction but is too fast for many patients and needs to be adjusted for individuals. If you were already having problems at 12.5mg you shouldn't have been told to reduce further and certainly not 2.5mg at a time - you may manage 1mg much better although a 17.5mg step between 20 and 15 would have served you better too. There is no point staying where you are as you will be back where you started very quickly and are getting into a yoyo pattern of dosing, reducing too soon, letting the symptoms flare and needing more - from experience we know this is a really bad thing to do as with each flare it gets harder to get things under control again.

[Tilian in reply to PMRpro]

Thanks for your reply, I phoned Doctor today so I have to go and get bloods done to check my inflammation level, I am off work just now with stress so he wants to make sure it is inflammation and not stress that is causing the pain before I increase dose

[PMRpro Ambassador in reply to Tilian]

Suppose how you look at it - stress affects the immne system and is enough to cause a flare, even trigger PMR in the first place. The inflammation markers aren;t reliable in a patient on pred, their rise can lag a long way behind symptoms, symptoms rule!