If one is on HC as a pred replacement, what happens if one has a suspected PMR flare............ would one raise the HC at the same percentage as one would do with pred??? (HC needs about four times the pred dose i assume).......,,,,,,,,
Then , if staying on HC for a while ,does the tapering doses still apply at the corresponding percentage as one would do with pred ???????
The tapering of the HC is something to discuss with the endocrinologist who is using it in the hope of improving adrenal function.
To be honest - HC isn't very good at managing PMR so a flare may well require a bit of pred. A bridge to cross when you get to it maybe?
You are dead right about HC not controlling PMR as does pred....My 7Mg pred was keeping things under controll, while the equivalent in HC(30 Mg)
just does not do the job .........I double the HC dose for a couple of days every week or so as required , ..........But then again is it PMR or an adrenal thing
I have one more test (ACTH stimulation ) to do before seeing the Endo bloke again ......
Part of the problem is that the anti-inflammatory effect of HC just doesn't last as long as that of pred. It might be worth asking if you can take a bit more - but it really is something that is up to the doctors. And as MrsNails says, maybe you should be on a mix of pred and HC in the event of a flare - but their call really.
As most of us take Prednisolone or a form of - l think this needs a reply from a Medic ie Your Rheumatologist and/or your Endocrinologist(if you have one) to ensure you have the correct information. Kind Regards
MrsN
As an aside, my Mum was on Hydrocortisone as she had adrenal insufficiency following long term Prednisolone for Asthma (60mg per day)
Once she was off Pred & on HC if she ever had a bad asthma attack or chest infection she was always prescribed a short course of Prednisolone & to continue with her HC as usual.
Thats interesting............
PMRpro is correct. I don't think hydrocortisone works as well as prednisone. My endocrinologist required I go down to 4mg prednisone and then do the switch to hydrocortisone in order for her to check my adrenal function. I got down to 4mg in February, taking 20mg hydrocortisone in the morning and 20mg before 2pm daily. I've been quite miserable since. Last lab done, my CRP was 0.8. University of MIchigan Lab CRP range is 0.0 - 0,6 mg/dl. My doctors were not concerned about my CRP being over the range a little. They're saying there is no inflammation in my body and to keep on taking hydrocortisone as it can take a long time for the body to adjust being off prednisone and for the adrenals to 'wake up'. I was diagnosed PMR in 2018 taking prednisone the last 4 years getting down to 6mg prednisone a little more than the last year. Seems the hydrocortisone is doing a number on my body more than the prednisone. My weight is up even more. I have bilateral upper arm pain 24/7, bilateral outer hip pain, fatigue, and just feel like a blown up balloon. I'm scheduled for an adrenal scan and more labs this coming Tuesday. Then they will determine my course of action. I presume if my adrenals are working, they will devise a plan to reduce off the hydrocortisone. That's their plan. I suspect a different one. (back on pred.) Best of luck to you from the U.S.
Thanks ......I was on 7Mg pred and the endo bloke put me on 20HC morning and 10HC at 2pm ,i suspect that is not enough, .........any how i had the stimulation test a couple of days ago and waiting on other test results before seeing the endo bloke again to get all the results together and see what happens next. ..............Best of luck to you too ...............
Endocrinologist and Hydrocortisone
Day 2 of the swap to Hydrocortisone.
Continuing with hydrocortisone after synacthen test or go back to pred? Dilemma 🙄
Tapering, 
To Taper or Not?
