Should I increase my Pred dose?

[AgMuirhead]

Hi! I was diagnosed with PMR in October 2022 and started on 15mg of Prednisolone for 4 weeks. I reduced to 12.5mg and stayed there until February then reduced to 10 mg until mid-March. Since then, I was reducing by 0.5 every couple of weeks. All felt well until I started to feel pain on waking in my right wrist and my right elbow and then some discomfort in the backs of both legs from just under the buttocks to the backs of my knees; by this time, I had arrived at 7/7.5mg. I increased to 9mg then, last week, to 10mg. The wrist pain seems to have gone but the elbow is still sore, easing off 3 hours after I take the pills.

My question is, should I increase my dose to 12mg and, if so, how long should I stay there?

Thank you for sharing all your knowledge, information, advice and suggestions on this forum. It has been an invaluable resource thus far!

[piglette]

Normally it is suggested you go up by 5mg for a week or so to really hit the PMR on the head and then drop back to the last dose with which you felt comfortable. Reducing by 0.5mg every couple of weeks is probably too fast, personally I would reduce every four weeks.

[AgMuirhead in reply to piglette]

Thank you.

[DorsetLady PMRGCAuk volunteer]

The problem with reducing every 2 weeks even though it may have only been 0.5mg is that you aren’t on current dose long enough to know it is really enough before you drop to lower dose.

Do that a few times in succession and you don’t KNOW what was your best dose. Do it more slowly and you have a better idea of what is enough, what is just edging on not quite enough -and what is definitely not enough ..as you have discovered.

This link contains advice on dealing with a flare and says add 5mg to the dose you last felt okay-that may be a bit difficult in your case. ..but give it a whirl and go back to 12mg and follow suggest timings.

Then when you drop back down try 8mg or 8.5mg as your new starting point. Most people find below 10mg a drop of 0,5mg per 4 weeks is achievable.. no quicker..

healthunlocked.com/pmrgcauk...

Are you sure you haven’t done anything to your right arm -or is that a peculiarity of your PMR?

[AgMuirhead in reply to DorsetLady]

Thanks for your responses.

My first instinct with any ache or pain is to NOT assume it’s PMR as I did with the wrist (I’d travelled with a suitcase a couple of days before). That was at the end of April and I had it intermittently until I went back up to 10mg. The elbow has been making itself known now for about 4/5 weeks. (When I was first diagnosed, I had neither wrist nor elbow pain. I first had pain in my left groin, bi-lateral shoulder and upper arm pain, worse on the right side, and bi-lateral girdle and upper leg pain). It wasn’t until I started with the discomfort in the backs of both my knees and thighs and intermittent groin pain that I suspected it might be the start of a PMR flare.

I might add that I only know all/any of the above because of the information I’ve gleaned on this forum, not from anything the multiple GPs who have contacted me have told me. They just seem very keen to get me off the steroid asap, some more than others!

Thanks, once again.

[PMRnewbie2017]

All good advice above so I won't repeat it but for the benefit of others reading "You fell into the tiger trap didn't you!" Been there and done that too in the early days. The Pred will mask any other underlying inflammatory issues and a slow taper is the only reliable way to find your own personal dose requirement. The tortoise always beats the hare in PMR so please prepare yourself psychologically for that. Very few people are totally off Pred and PMR free in 2 years. You will get there ......

[AgMuirhead in reply to PMRnewbie2017]

Thank you! Will definitely take heed of all advice given.

[Hageman]

Hi I stared at 25 few years ago got down slowly to 3 had flare of pain so went up slowly to 8 and had small mounts pain but reasonable. And was ok . So I would say. Go up slowly you may still get some pain but the lower the dose the better for your body . Then try coming down again in future you may be lucky and get to a low low dose . Hope this helps A bit

[PMRpro Ambassador in reply to Hageman]

Increasing the dose slowly isn't recommended - you are always playing catch-up, Better to hit it hard for a few days and go back to the last dose that was really good or judge it by how you get on adding the 5mg.

[Hageman in reply to PMRpro]

Well doc told me up by 2g each time. . worked for me.at the time ... But as on metatrate now as well hard to tell these days lol