Increase in fatigue as reducing?

[Lyra42]

See bio for full story, but reduced from 17mg Pred to 16mg on 1st March. Only slight increase in stiffness in shoulders but very noticeable increase in fatigue.

Question is, should I take account of increased fatigue and stop reducing? Or should I carry on reducing and stop if pain/stiffness increases?

Thanks

[SheffieldJane]

What is your current dose of Pred?

Are you still on other medications?

[Lyra42 in reply to SheffieldJane]

currently on 16mg Pred. Other medications: citalopram 20mg daily for menopause symptoms, and the usual stuff for PMR (alendronic acid, calcium & vit D and omeprazole)

[SheffieldJane in reply to Lyra42]

I think at your stage I would want my doctor to explore other reasons for the fatigue, just in case there is something else going on. You need to ensure that you are not overdoing things just because you feel a bit better. Pred is a bit like a painkiller it has no effect on the underlying disease. It simply relives the symptoms as the disease carries on. Lots of rest and avoiding stress is important. Learn to pace the activities you do. It is a new way of being to get used to for the duration. Have you looked at tapering programmes in FAQs? It is important to get that bit right.

[Lyra42 in reply to SheffieldJane]

Thanks. I’ve just gone through a very thorough health check (blood tests, ultrasounds, full spine MRI, chest x-ray) because the rheumatologist thinks I’m too young to have PMR! All tests come back clear so I’m pretty sure it’s PMR ( as I have been all along through reading this excellent forum!)

As I understand that Pred only deals with the inflammation, my reasoning is that if the stiffness does not increase, I can keep reducing despite the increased fatigue?

[PMRpro Ambassador]

At that dose it shouldn't be an adrenal problem yet. It MAY be that you are getting close to flaring but that is a pretty high dose for PMR unless you are still working. If you are menopausal then the fatigue might be due to that.

Your doctor is totally wrong on one factor - age is not a reason to say it isn't PMR. Struggling to reduce at that level may be. What other tests has he done?

[Sharitone]

All I can say is that I have always had the fatigue, and it doesn't seem to have been affected by the pred dose. So if I had waited for it go away before reducing, I wouldn't have got very far!

As SJ says, you might want to get the GP to check out the fatigue: not everything is PMR-related. Also, I hate to say it, but increasing fatigue a few months after starting pred for PMR was the first symptom of GCA for me.

[Lyra42 in reply to Sharitone]

Thanks. Yes I’ve found the fatigue to be the worst from the start. I think I might have been too cautious about reducing - hence why I’m cautiously reducing by 1 mg every 3-4 weeks at the moment. 16mg has been the lowest dose I’ve been on since I was diagnosed last May!

[Sharitone]

I think I would continue with your cautious reduction, and only stop if pain and stiffness increase. Seeing as the treatment your rheumatologist gave ended in disaster, I should have thought you needed some more input now. After all, if s/he thinks it's not PMR, then you have effectively not been diagnosed or adequately treated. Good luck!🙂