Reducing pred after 10 days on sick day rules cos of covid- advice please.

[Grannyasbo]

Need some advice please again. Just getting over Covid. Tested positive on 22nd Dec. Before Covid I was doing a slow 0.5mg at a time taper (DL taper plan 🙏) and was on 5.5mg feeling exhausted and had pain in upper arms and upper thighs etc etc. I was tying to unpick whether this was due to tapering reaction, exhaustion from 24/7 caring duties or a PMR flare with help from this wonderful forum. Then covid hit…

GP advised I follow sick day guidelines through my Covid illness and take 10mg pred in mornings and 10mg at night. I did this for two days and then reduced it to 10 mg morning and 5 mg at night as felt 20mg was over doing it. Then I reduced it to 10mg in the morning only for last five days and did ok on that. 

The pain in my upper arms and thighs disappeared almost immediately (couldn’t enjoy that because of covid, though was very thankful). I am now recovering from Covid and still pain free (yay!) though still tired from covid but feels different to previous exhaustion. Am now wondering if I should immediately reduce back to 5.5mg or start a slow taper from 10mg again or reduce quickly from 10 to 5.5mg over a few days. Or what? Any suggestions experiences with this as always very welcome. All guidelines say consult dr if increase is longer than a week. But my GP is on holiday till 10th Jan and don’t trust anyone else at the practice.

Happy new year to you all. Thank you in advance for your thoughts. GA

[DorsetLady PMRGCAuk volunteer]

I would take it in 2 steps down -to 8mg initially for 5-7 days and then down to 6mg for 3-4 weeks before resuming tapering plan.

[Grannyasbo in reply to DorsetLady]

that sounds like a wise and sensible approach thank you thank you thank you for everything. HNY x

[PMRpro Ambassador]

Think you have shown some of those aches were PMR because the dose was too low. If it were me I'd go to 7.5mg and see how you fare there, If that is OK - maybe 6 or 6.5mg. But I would approach 5.5mg with caution - can you remember if the aches started earlier?

[Grannyasbo in reply to PMRpro]

I have aches with every step but they reduce. The thing about getting to 6 and then 5.5 is they didn’t really go away and fatigue got worse. But this was combined with new and significant caring responsibilities and everything that goes with it. Am liking the two step approach you and DL are suggesting. Will definitely do that and as you both suggest approach 5.5 with extreme caution.

This is a grim dance we have with pred and PMR isn’t it.

Wishing you a wonderful 2023 with many thanks GA

[piglette]

As DorsetLady suggests I would take the reduction in two steps. The tiredness may also be due to the adrenal glands that are having to start waking up below 7mg. I became zombie like around 5mg. When you reduce one often gets steroid withdrawal for the first couple of days or so but it then goes away.