Reduce or not to reduce

[Retallack]

I have been doing the DSNS method 0.5mg at a time since 5mg and have now reached 1mg. I have stayed on 1mg for 3 weeks as 1st thing in the morning I have a little stiffness in the shoulders but by the time I go downstairs to make a cup of tea it has disappeared. I have no other problems and am doing aquafit and other low impact exercises with no problems. Should I try going down to 0.5mg ? Thanks for any input.

[PMRpro Ambassador]

Why are you asking? Why do you suddenly feel there is a question about what to do next? The only things I would consider is 1) staying at 1mg for a few more weeks and then aim for 1/2mg but also 2) asking the GP to do a basal cortisol - cortisol measured on a blood sample taken between 9am and 1pm - to get an idea of the state of your adrenal function, at least in terms of day to day function. It might then be worth asking for a synacthen test to assess how well it has recovered but it is well known that that can take up to a year even after stopping pred altogether.

[Retallack in reply to PMRpro]

Thanks for the advice. I am asking because I don't know whether reducing now to 0.5mg would increase the stiffness and I don't want to go backwards ! I will stay at 1mg and ask for a basal cortisol test first as you suggest. Sage advice.

[PMRpro Ambassador in reply to Retallack]

No-one knows - there is only one way to find out. When you do try, sow the slowed taper down ever more, repeat steps and be ready to stop where you are.

[DorsetLady PMRGCAuk volunteer]

I would stay on 1mg for longer and see if the issue resolves.

You may well be just on the edge of enough Pred/not quite enough, so no point in pushing on.

Of course it may not be PMR, but until you are sure, just stay where you are -1mg is a very low, so remaining there until you are certain is no great shakes.

Very often the last couple of steps are the most difficult to achieve…as has been proved many a time 0.5mg really does make a huge difference.

[Retallack in reply to DorsetLady]

Thank you. I will stay at 1mg for longer and ask for a basal cortisol test as PMRpro suggests. Fingers crossed.

[Viveka]

Stay on it for longer. What's the rush? You are doing really well, on a tiny dose and it is worth being kind to yourself and being safe rather than sorry, particluarly as you have some minor symptoms. 3 weeks proably not enough to tell if you are stable on a dose.