Discomfort vs flare in tapering of prednisolone

Dear Members,

It’s great that thru this health forum, I am able to gain information on various topics on PMR.And to thank members for sharing their life experiences having this medical condition so called: PMR.

I have so far managed to taper my prednisolone to 4mg since the 27th of March 2022. I am now experiencing a little discomfort, I say I am on 1 of the scale from 1-10, (10 extremely painful) around the neck muscles, shoulder blades and fingers/ thumbs , but during the course of the day, the discomfort tends to subside.

My question : is the term flair indicates that symptoms are more to the extreme of the medical condition? And the question of discomfort means the adrenal gland is working harder to produce the hormone cortisol?

I have never had a flair , apart from the initial phase of my PMR ( had encountered all the medical symptoms of PMR in the July/August 2021.

Many Thanks

[DorsetLady PMRGCAuk volunteer]

This explains difference between flare/steroid withdrawal -

healthunlocked.com/pmrgcauk...

This link explains all thing adrenals - healthunlocked.com/pmrgcauk...

[Hidden in reply to DorsetLady]

Hi DorsetLady,Many Thanks for the link which was posted 11months ago. I have copied and pasted on my notes on my phone.

Take care

[DorsetLady PMRGCAuk volunteer in reply to Hidden]

I know it was posted 11 months ago -written my me -and it’s included in the FAQs

[PMRpro Ambassador]

Every journey starts with a single step!

If the new pred dose is even slightly too low, then there will be a bit of inflammation left over when the pred has done what it can each day. And even a slowly dripping tap will eventually fill a bucket and overflow. So the question is: does the discomfort remain stable or does it build up over time? It may be just the adrenal function taking its time to get back to work - but in that case the discomfort will remain stable or improve, albeit only slowly. But if it gets worse - that is a sign you may be building up to a flare and return of symptoms and taking a bit more pred may be sensible, especially at low doses as you are on. It can take months sometimes to get to pain and a full-blown flare - and it pays in the long run to avoid that scenario and needing to go back to a higher dose.

I don't think there is any link between the effort required on the part of the adrenal glands - it is a lot more complex than that!

[Hidden in reply to PMRpro]

Hi PMRproMany Thanks for the information.

I need to be mindful of the discomfort and proceed cautiously with further tapering of the prednisolone.

Kind regards

[PMRpro Ambassador in reply to Hidden]

I would suggest not tapering at all for at least a couple of months - see what happens first.

[Hidden in reply to PMRpro]

I will continue with the 4mg for the next 3weeks at least and continue to observe my discomfort before reducing any further.Thanks

[PMRpro Ambassador in reply to Hidden]

Believe us - the slower you go at present, the more likely you are to succeed!

[Hidden in reply to PMRpro]

I totally agree and understand that you members have the first hand experience with this medical condition. I will pause tapering the prednisolone and see how I get on. I am due to have bloods done end of April 2022. I will request for serum levels , vitamin D and other routine bloods to be done, together with my ESR and CRP levels to check if any inflammation.Thanks

[Bncc]

HiI had a nudge to reply to you as I have had the same questions answered by Dorset Lady and PMRPro before; they are a source of helpful information.

I came down very slowly from 5mg a day by 0,5mg per week, that is from 35per week to 34.5 the next week and so on. I am now on 2.5 mg. No morning pains yet and I will now stay on 2,5mg for several weeks as I have plenty of those black pills. I still am keeping some 5mg ones in case of a problem. Fingers crossed.

Good luck

[Hidden in reply to Bncc]

Hi BnccHope all goes well for you.

I have been tapering by 0.5mg once a fortnight only after January 2022. and so far so good. I will stay on the 4mg till end April 2022, will have bloods done then . The results of the inflammation markers( ESR and CRP) will indicate if i am doing well with tapering of prednisolone, prior to proceeding further to reduce the dosage.

Take care.