Flare and reducing pred.

[Oscardoggy]

I have had PMR and RA for approx 2.5 years. I have been taking prednisolone in varying doses since then but have had several flares necessitating an increase each time. I managed to get down to 6 mgs but had yet another flare. My rheumy increased the dose to 10 mgs but said to reduce straight back down to 6 mgs after 2 weeks but the increase did not relieve my symptoms fully. My question is, is this too much of a drop or should I ask for a much slower taper? Thank you

[DorsetLady PMRGCAuk volunteer]

This link contains usual advice for dealing with a flare - so much in line with Rheumy and you should be able to drop back down -

healthunlocked.com/pmrgcauk...

… but with a slight difference, in 2 steps and to just ABOVE the dose you last had issues. If you had problems at 6mg two weeks ago you are likely to still have same problems today -If it’s too low, it’s too low.

Do you have enough Pred to repeat the procedure as per link? Going to 11mg rather than 10mg - might sound pedantic - but 1mg can make a difference.

Plus if you are flaring repeatedly, then maybe you are reducing too quickly so try using a slower tapering plan - see here -

healthunlocked.com/pmrgcauk...

just one more thing - you are also at the level where your adrenals need to come out to play, so have a look at this as well - slower tapering will help with them as well -

healthunlocked.com/pmrgcauk...

[Oscardoggy in reply to DorsetLady]

Thank you so much for your reply and advise. I have read all the links and the advise is invaluable. Just need to convince my rheumy that a dead slow taper is the way to go.

Thanks again, much appreciate.

[DorsetLady PMRGCAuk volunteer in reply to Oscardoggy]

Just need to convince my rheumy that a dead slow taper is the way to go.

Ah yes, well good luck with that one !

[Oscardoggy in reply to DorsetLady]

I’ve got 3 months until my next review so may just reduce slower and see how it goes.

[123-go]

’Yes’ in answer to both questions. The fact is that PMR marches to its own drum rather than the doctor’s. Have a look at slow tapering plans in this link found in FAQs:

healthunlocked.com/pmrgcauk...

Best wishes.

[PMRpro Ambassador]

You aren't reducing relentlessly to zero - you are looking for the lowest effective dose, the lowest dose that gives the same symptom relief as the starting dose did. If you repeatedly flare at a similar dose, that is your body telling you that you have arrived. Repeatedly trying to force a step down and allowing a return of symptoms can be counter-productive in the long run as it becomes increasingly difficult to get the symptoms under control.

If we had suggested the increase we would have said go back to 11mg (5mg above the dose where the flare occurred). It maybe sounds not a lot but 1mg can make a BIG difference. The drop per se is OK - but you are probably not on enough pred.

[Oscardoggy in reply to PMRpro]

Thank you for your reply and advise. I have been yo- yoing for 2 years. I was on 30 mgs at one stage but can’t seem to get much below 10 mgs. I think a dead slow taper is the way to go.

[PMRpro Ambassador in reply to Oscardoggy]

There is a group of us who have had difficulty getting below 10mg - it appears to be one of the versions of PMR that is seen,

[Denbo51]

It should be a milagram a month,that's to much in one go,I'm still on 5mg but dropping to 4mg next week after a month,this what doc told me to do.hope this helps.

[christine2715]

Far too fast. Once you get below 10 its only 1mg per week max and 6 i would just drop to 5 one day of the week then next week make two droos to 5 in the week and so on. It can take 6 or 7 weeks to drop 1 mg completely. Slow is best. Also you can get 2 1/2 mg tablets so poss to drop 1/2 mg at a time. Best wished, Gaynor