unsure how to increase prednisone with flare

[Malaga47]

Diagnosed with pmr on 1 November and started on Prednisolone 15 mgs. This was increased to 20 mgs after 3 days as the 15 hadn’t helped, Was on 20 mgs for 18 days and told to reduce to 15mgs. This seemed to be too big a reduction as symptoms returned so Pred was increased to 17.5 for 10 days. Reductions then went 15.5 for 15 days, 13.5 for 14 days, 11.5 for 14 days, 10mg for 28 days, 9mg for 28 days, 8mg for 20 days (whilst on 8mg symptoms were grumbling away again but including very painful wrists and hands). Told by GP to increase to 9mg which I have done for 2 days but this morning my symptoms are the most severe they’ve been since original diagnosis though not quite as severe. Has anyone any idea what I should have increased to. Any advice would be appreciated.

[DorsetLady PMRGCAuk volunteer]

This link [from The FAQ section] contains information of how to deal with a flare -

healthunlocked.com/pmrgcauk...

..and an increase of only 1mg is highly unlikely to be enough... just adjust the levels to your own circumstances - but I would say up to 13 or 14mg...

..and then once back on track maybe only reduce by 0.5mg a time...not 1mg.

[Malaga47 in reply to DorsetLady]

Thank you for your help.

[PMRpro Ambassador]

I would add 5mg until the symptoms are gone - up to a week or so and then back to 9mg, ANd taper more slowly from now as DL says.

[Malaga47 in reply to PMRpro]

Thank you so much for your help.

[piglette]

If I had been told to reduce like you have I would be a nervous wreck by now. It does not help that you have been forced into a yo yo situation. As PMRPro says, increase by 5mg so you can hit the PMR on the head. Hopefully you should then be able to drop back by 3 or 4mg in a week or so.

[Malaga47 in reply to piglette]

Thank you but could you clarify if I increase to 15mg daily for a week and it settles my symptoms do I reduce by 3 or 4 mg straight away or by 1mg for several days and then another mg and so on until I reach 8 or 9mg a day again. Sorry to bother you but your help is much appreciated.

[piglette in reply to Malaga47]

You can actually drop straight back without tapering if you do it within two weeks of upping the dose. It is probably better to do it in two steps and drop back to say 1mg above or the last dose you felt OK.

[Malaga47 in reply to piglette]

Brilliant. Thank you again for your help.

[Mewy]

After reducing from 15 to 12.5 to 10 mg each 30 days I started reducing by 1 mg every two weeks as per my NP direction. I am currently on 5mg without any flares. It is important to know that everyone is different. You must find a dose that gives you relief from the flares even if it means going up. The PMR Pros here are your best advisors. This is my second go-round with PMR and I feel a more able to deal with the ups and downs. All the best.

[Malaga47 in reply to Mewy]

Hi Mewy thanks for your reply. I see from one of your previous notes that you have experienced painful hands and wrists. I have had this since reducing to 8mg but my GP states this can’t be the cause! I’m sure it is the reduction that has caused it as it becomes painful during the night, is extremely painful in the morning and like you I can’t open doors and have no strength in hands or wrists. Should mention that by late afternoon they are much better and by night I have no pain at all. Should say I’ve not seen GP and it was during a telephone conversation she said wrists and hands were not connected to pmr!

[Mewy in reply to Malaga47]

I think there are other people on this site that have had wrist and hand problems. I feel pretty confident that my wrists and hands were related to PMR as the pain went away with the Pred. As the PROs will tell you not every doctor understands the nuances of PMR. I think you have to try a bit of a higher dose at the amount when you had no pain. If your hands and wrists respond then stay there for a period of time (3-4weeks?) And try tapering again. There is also a tapering program at this site called dead slow which helped me with the first episode of PMR that I experienced.

I will try and find it and send it to and you could try it.

Mewy

[PMRpro Ambassador in reply to Mewy]

You will find all the versions of tapering schedules under tapering in the FAQs