Tapering

[maureenburton]

If you start on 15mg when do you;start tapering and to what dose? Thank you

[DorsetLady PMRGCAuk volunteer]

You should have been given advice by your doctor....but obviously weren't!

My personal view is one month at least at initial dose... and preferably on each step same time..

However the guidelines state following which may or may not be achievable -

"This is tapering regime from guidelines -

The suggested regimen is:

Daily prednisolone 15 mg for 3 weeks

. Then 12.5mg for 3 weeks

. Then 10mg for 4–6 weeks

. Then reduction by 1 mg every 4–8 weeks or alternate day reductions (e.g. 10/7.5mg alternate days, etc.)

**However, there is no consistent evidence for an ideal steroid regimen suitable for all patients.

Therefore, the approach to treatment must be flexible and tailored to the individual as there is heterogeneity in disease course.

Some benefit from a more gradual steroid taper.

Dose adjustment may be required for disease severity, comorbidity, side effects and patient wishes."

* note the comments - these are just guidelines, not everybody is able to conform.

IF you cannot manage the 2.5mg drop from 15 to 12.5 and 12.5 to 10mg - then either cut your 2.5mg tablets (so long as they are plain white coated ones ) or request 1 mg...

[maureenburton in reply to DorsetLady]

Thanks - very helpful

[PMRpro Ambassador]

What DL said - BUT, before you start to taper, your symptoms must be well improved and stable. Has 15mg achieved a good result?

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

maureenburton Yes, forgot to say only if all okay...

[maureenburton in reply to PMRpro]

Yes but waiting to see rheumatologist as not convinced I have PMR. Have had it before. Hoping I can come off sooner if they feel it's not PMR too.

[PMRpro Ambassador in reply to maureenburton]

If it isn't PMR - what do you think it is? PMR isn't the disorder - it is the name given to a set of symptoms caused by an underlying condition. And there are several.

[maureenburton in reply to PMRpro]

Maybe carpal tunnel as only affected my arms and hands.

[PMRpro Ambassador in reply to maureenburton]

Nowhere else at all? Who suggested PMR?

[maureenburton in reply to PMRpro]

GP because of elevated ESR but I've recently had knee replacement so ESR going to be up and down hence why I want to see Rheumatologist.

[DorsetLady PMRGCAuk volunteer in reply to maureenburton]

See this re my raised ESR - couple of occasions- not always PMR/GCA -

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador in reply to maureenburton]

Numpty - a raised ESR can be any one of a thousand things, not just PMR ...

[piglette in reply to maureenburton]

My ESR went up to 415 after a hip replacement.

[piglette]

My rheumatologist got me to reduce at three weeks from diagnosis by 5mg which was a total disaster. Normally your doctor should give some directions. On the other hand you will probably get better advice from this forum, as the people on here have actually been through it!!

[maureenburton in reply to piglette]

I know! That's why I'm checking in here first!

Thanks

[singingloud]

Your bio says you joined in 2018. Is that when you were diagnosed with PMR? Have you been in prednisone since 2018 and now just tapering? Strange that you only have pain in your hands.

Years ago I had carpal tunnel surgery and then a few years later the other hand. This took care of my pain that ran to my shoulders. This happened way before PMR. I didn’t need a rheumatologist for diagnosis of carpal tunnel just a hand surgeon.

ESR is sensitive to any kind of inflammation.

[maureenburton in reply to singingloud]

I had one 2016 to 2020 and been fine since then until I had knee replacement few months ago. Presuming it's that trauma that's started it again, if infact it is PMR.

[singingloud in reply to maureenburton]

You had carpel tunnel surgery those two years?

[maureenburton in reply to singingloud]

Sorry auto correct , I had PMR 2016 to 2020. No didn't have carpal tunnel then.

[singingloud in reply to maureenburton]

Gotcha thanks