I have dropped from 1.5mg to 1mg at my usual 4 weekly intervals and now having aches in the back of my neck, elbows and hands are tingling. I increased my pred to 3 mg today and wonder if it’s enough? Not sure how to proceed at such a low dose.
Any help would be very much appreciated.
Thank you.
I don’t think we can say whether it is or not -you’ll just have to see - but usual advice is to increase by 5mg for 7-10 days as described in this link -
healthunlocked.com/pmrgcauk...
The general advice is the same at whatever dose you flare - but at such low doses you may find you can get away with a smaller increase - so you have to see.
Thank you for your prompt reply. I’ve had a stressful year with my husband passing away unexpectedly in May and 2 Weeks later my sons wedding and was well prepared for a flare up as was such a stressful time but nothing came and continued to decrease by .5 mg per month with no problems until now.
Condolences on loss of hubby 🌸, but sometimes it takes time for the body and you to show any reaction…and the first Christmas (probably more so than other firsts) can be more stressful than you anticipate.
Having been there, I would suggest you take a little more than the 3mg you mention….it will be difficult for the next few weeks, so you’ll probably need extra - then hopefully you can get back down afterwards with no more problems.
Thank you and sorry for your loss too. I will go up to 5mg for 5-10 days and see how it goes. I hope you have a Happy Christmas with warm and comforting memories. X
Sorry to hear about your husband. It was 6 months before it hit me when my husband died just over a year ago. I found Christmas was fine but it was later it bit. But everyone is different.
You have to see how you go with the 3mg, it depends how quickly you caught it. But as you go down again I'd stay at each dose a couple of months - the lower, the slower.
Thank you and sorry for your loss. The lower the slower makes a lot of sense. I just followed Rheumy instructions.
Your last sentence says it all! Unfortunately 😳
Hello,Stress always eems to manifest itself in physical symptoms when you least expect it. There are several articles that say that polymyalgia is stress related, so no wonder that any further stress aggravates it. You have had a bad time followed by an extremely busy one, which must have taken its toll on you when you were already feeling low. Both events acting on your emotions in different ways. No wonder you are having a flare. Hopefully with the suggestions re steroids here on the forum, you will get over it and be back to a lower dose in a relatively short time. Congratulations on achieving your former low dose by the way, you will soon be back to it and hopefully you will feel better and soon be able to do without steroids altogether. I wish you all the best for the future.
Oh - that has been a stressful year, and managing PMR on top of it all. I hope that 2023 brings good things for you.
You don't say whether you are using the DSNS method of tapering your reductions (I hope you are). I found that when I was reducing my dose at very low levels (when it is impossible to stick to the 'no reduction greater than 10%' rule), lengthening the time it took to taper helped my body become accustomed to the lower dose.
My theory (as a non-medic) is that it takes a long time for your adrenal glands to get the message that your immune system is a bit low on steroid and that it needs to produce some more. So, if you gently 'nudge' it over a longer period of time, it might help!
And as is oft repeated on here - it's not a race to zero...
If you were not experiencing any PMR symptoms at 1.5 mg after 4 weeks, either the PMR activity is at or below that dose. Or barely above such as the inflammation is taking quite a while to build. You literally doubled your old dose. I’d stay at 3 mg for a couple of days and see how it goes. If the pain goes away, within a day or 2 I’d say you’re fine and after a few more days with no pain go back to 1.5 mg. If 3 isn’t enough, try jumping to 5 mg.
I wouldn’t be to quick to jump a rather large increase. See how it goes. What was the pain level when you increased to 3 mg? Has it gotten any worse, stayed the same, or decreased? That should be your guide. Also matters how long did you wait to respond when pain started, same day increase or did you wait a few days as the pain increased?
Hi thanks for your information. I increased yesterday after 4 days of pain gradually getting worse. I added 5 mg to the 1.5 and feel better already today. I will see how it goes over next 4 days and if fine will drop back down again to 2 mg and stay there for a while.
Maybe a few more days at the higher dose -just to be sure.
yes for sure. Thank you.
I think most people really do need a week at least - you aren't the first this week to be in a hurry!
Yes, for the future I suggest not postponing increasing the dose when you feel pain coming on. I’ve actually increased my new dose back to old dose by the step decrease on same day of feeling pain, depending on its intensity. Don’t wait 4 days as it puts you behind the 8 ball, so to speak. Best wishes.
Just to add something else. Dropping from 1.5 to 1mg is a huge 30% reduction. Also I really feel at these low doses you should not taper monthly as it is not long enough for your body to cope. Personally I feel 8 weeks is better. Sadly we cannot tell if your pains are a flare or withdrawal. Have you tried the paracetamol test? If they sort you out it's not a flare. Also there are many who suggest not tapering in the winter. You mention pains in hands and elbows, do you have any osteoarthritis?I'm transitioning to 2.25mg and been on this journey for 5 years. I've learned that not all aches, pains and soreness are flares.
Sorry to hear about your loss. Take care.
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