should I increase my Pred before cataract surgery?

[JEMOK]

My GP has insisted that I reduce my pred asap & I have tapered down at 1mg 4 weekly & am currently on 5mg. I have awful pain in shoulders & hips so have refused to taper any lower at present. I am having cataract surgery under anaesthetic next week & am wondering if I should increase my dose to help me through this or do as my GP says & stop pred altogether before the surgery. Any help will be really appreciated thank you

[DorsetLady PMRGCAuk volunteer]

No need to stop Pred for cataract surgery, I was on 9mg when I had mine done, no issue whatsoever…many on similar doses. Wouldn’t normally suggest an increase though.

It certainly does sounds as if your dose is too low for your PMR, and why is your GP insisting you reduce your dose so quickly, you haven’t reached the 2 year mark yet?

[Nextoneplease]

Hi JEMOK 😊

I agree with DorsetLady. I had my cataracts done when I was on 12.5mg, no problem. No need to alter dose for the op.

It does sound as if you may in fact be on too low a dose for your PMR symptoms. I wonder why your GP is insisting you reduce relatively quickly? The risk you run is of the inflammation building up and a flare starting. So irrespective of the cataract op, I’d be discussing raising your dose. When did you last feel comfortable? I’d say that’s the dose you need.

Good luck, let us know how you get on 😊

[piglette]

As the others say it sounds like you are on too low a dose. Reducing by 1mg every four weeks under 7mg I find is a bit high. It is better to reduce by 0.5mg every four weeks at that dose, particularly as the adrenal glands are being asked to leap into action again!

[DorsetLady PMRGCAuk volunteer in reply to piglette]

"leap?"...stagger more likely.😲

[PMRpro Ambassador]

My first recommendation is you do your best to find a competent GP who has some idea about the use of pred at all and particular in PMR. I can barely believe what I'm reading!

At 5mg your body is still dependent on the pred to function and stopping it suddenly for the surgery would very definitely put you at risk of an adrenal crisis which could put you in hospital, even ICU. The surgeons vary a lot in their reaction to patients on pred - some will happily operate at pretty much any dose, other refuse until the patient is off pred - and every shade in between. You will be given hydrocortisone through a drip during the operation - make sure that the anaesthetist knows you are a long term pred patient and tell THEM, don't rely on a nurse telling them. You will see the anaesthetist before they put you under - don't forget!!!

As far as managing PMR - you are not reducing relentlessly to zero, you are looking for the lowest effective dose. That is the lowest dose that gives the same relief from symptoms as the starting dose did. You are past that if the shoulder and hip pain is back. You should be at the last dose you didn't have that,