Flare caused by dosage change?

[craighead72]

On Pred since April for PMR. Dosage at mid September 16mg. Reduced to 15 then 14 by 9 October as No PMR symptoms. Developed sciatica. Increased to 18mg for 3 days then down again to 14. Sciatica less but now wake with pain in both hip joints. Have I messed around with dosage changes too much or too quickly and if so do I go up to 18mg per day until pain reduces and then reduce very gradually over a longer period?

[PMRpro Ambassador]

Did the increased dose make any difference? A common cause of sciatic in PMR is piriformis syndrome and the stretches do often help greatly:

youtube.com/watch?v=qgbpYL_...(Not working as expected?)

is excellent for a start. There are other exercises you can try later such as the clam.

[craighead72 in reply to PMRpro]

Have done those exercises and doctor gave me amitryptiline and sciatica has eased but new pain in both hip joints in early morning - a flare? Should I add 5mg (from 14 to 19) for 5 days and if pain relieved then go to 15 and stay there for 2-4 weeks as indicated in previous posts on how best to taper. Would it help to split daily dose taking half in morning and half in evening.

[PMRpro Ambassador in reply to craighead72]

I'm getting a sort of dull ache in hip joints when I wake up - not sure what it is but I'm pretty sure it is linked to the much lower dose of pred. Pred eases osteoarthritis too. It eases as soon as I move.

That could be an option - is it getting worse as time goes on? That would suggest the onset of a flare. Splitting - only one way to find out. It doesn't have to be half morning, half evening. The usual advice is the bulk in the morning, say 2/3, and the rest late enough in the day to carry the effect over to next morning. If you take half not long before bed it may disturb your sleep. Experiment a bit.

[craighead72 in reply to PMRpro]

Thanks. Really helpful. Am trying 2/3 of dose at breakfast and 1/3 at early evening. Whatever pain I have early morning seems to ease off by lunchtime and is almost unnoticeable by evening then returns next morning. From my limited knowledge that seems classic PMR. Will monitor and experiment BUT taper slowly and gradually.

[PMRpro Ambassador in reply to craighead72]

It is - but various inflammatory substances are shed in the early morning and you are moving a lot less overnight and there are a few things that do improve with movement.

[craighead72 in reply to PMRpro]

Understood. I have even thought about setting alarm for 4am and if no pain getting up and moving around to see if that prevents pain. Then having a sleep in the afternoon or going to bed a couple of hours earlier than usual.