Confused - pred dose - flare or steroid withdrawal

[Laineydee]

Thanks in advance for your help and advice. Recently tapered successfully to 6mg after 2 years of PMR starting at 15. Tapering to 5.5 when after a month I had a flare up of very painful symptoms. Blood tests showed no significant increase in inflammation levels. GP advised an increase to 10 mg for a week and then return to 5.5. During this time I had a fall, was badly shaken and sustained a fracture to my finger. I therefore extended the period on 10mg to 12 days. On 10mg the pain subsided entirely. On reduction to 5.5 a week ago, the pain has gradually built so that after 5 days it was very intense again. It is now slightly better but only just tolerable.

My question is: is this pain because 5.5 is too low a dose, or is it sudden steroid withdrawal dropping from 10 mg to 5.5mg, in which case, do I persevere and hope my body will adjust.? I have read the links about flares and steroid withdrawal but can’t work out which this is or what to do.

Many thanks for your input.

[PMRpro Ambassador]

The fall could have been enough to trigger a proper flare/relapse by increasing the underlying disease activity which would need more pred rather than the flare being due to overshooting the dose you needed at a stable disease activity.

It COULD be your body protesting at the change in dose - but you need a few days to see that, That it built up rather than settling suggests to me you are flaring. You might not need 10mg though.

[DorsetLady PMRGCAuk volunteer]

Maybe your body telling you that actually need 6mg or 6.5mg for now.

Usual advice after a flare is to reduce to just above the level you flared -if it was too low then, it’s likely to be too low now . With or without the fall.

So may try 6 or 6.5mg and see if that helps.