Quick taper?

[Abbeynan82]

My CRP was rising and with lots of pain killers. Dr raised my 10 mg to 15 mg Prednisilone for 5 weeks. Now, CPR has come down by half and he is advising I reduce to 10 mg , via practice receptionist on telephone , with bloods again in 6 weeks. Question: Is this something like normal practice, and would you reduce all at once, or maybe 1 mg per week?? In 3rd year of PMR . I have flared several times at 7-8 mg. What say the experts?!

[DorsetLady PMRGCAuk volunteer]

We don't usually suggest staying on increased dose for 5 weeks when dealing with a flare, usually between 7-14 days. That way, you can reduce back down quite quickly, but as you've been on 10mg for much longer, that wouldn't be a good idea.

You can try 1mg every week, but that could be problematic if you aren't sure that each dose is enough (and one week often isn't to tell) ....

..or you could try 2 steps, so down to 12.5mg for 3 weeks, then down to 10mg for the second 3 weeks, that gets you to 10mg for next blood test.

For information this usual procedure for dealing with a flare -

healthunlocked.com/pmrgcauk...

..and maybe in future use a slower tapering plan (if not already) - couple here -

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

After 5 weeks I think to reduce from 15 to 10mg in one go is a bit much. I would try 12.5mg first - as if you were back to the beginning again. And then you still need a few weeks at that before going down again to 10mg. You have 6 weeks, so it is feasible.

REpeated flares at about the same dose is your body telling you that you have arrived at your destination. You are not reducing relentlessly to zero, come what may. You are looking for the lowest dose that works as well as the starting dose did which is probably about 8mg for you.

[singingloud]

I flared at 8mg and my PA had me go back to 15 for a month and then 12.5 for a month then 10. I then started the 45 days to 9.5 and now started another 45 days on the dead slow to 9. So far so good. When I get to 8.5 I will not move on unless I have no increasing pain. I’ve had PMR now for three plus years with around three major flares caused by rheumatologist pushing me to ten too fast. I think my lowest dose could be 8.5 for sometime.

Take it slow from one who has experienced too many flares and restarts. It’s your body.

[Abbeynan82 in reply to singingloud]

thank you, Singing! That all makes sense. I have a repeating pattern of sciatica when lowering Pred dose. I do not understand the connection at all!! During a flare, I have a return of aches and pains and start looking for pain killers, which don’t work very well. Pred gave me an ulcer, so cannot take non-steroidals. Right now, on 14 and leg very painful. Nothing much touches it except not moving! What a state we get into!

[PMRpro Ambassador in reply to Abbeynan82]

The sciatic pain may not be directly PMR but due to piriformis syndrome or greater trochanteric pain syndrome, both of which can happen in their own right but which are also more common alongside PMR and which respond better to targeted treatments rather than just upping the pred.

[Abbeynan82 in reply to PMRpro]

thank you Pro! I think I have both, and often see them mentioned in relation to PMR, or is it just age!

[PMRpro Ambassador in reply to Abbeynan82]

Not necessarily just age - had mine since my 30s. You can have piriformis on its own or it can be part of GTPS

[singingloud]

I have had lower back surgery and still have pain that runs down my leg most of the time. I found at 15mg my pain was less but it has increased now at 9.5. Hang in there.

[Abbeynan82 in reply to singingloud]

I have just hired home care! Tired of struggling ! The less I do, the less it hurts.

[singingloud]

I could use help with cleaning my floors especially.😅