NICE maths

[Mayadill]

• Reduce the dose of prednisolone slowly when symptoms are fully controlled. A suggested schedule for reducing prednisolone is provided below, but smaller dose reductions and longer durations at each dose may be needed to avoid relapses in some people. Typically, treatment is required for between 1–2 years.

o For people who are well controlled on 15 mg daily, a suggested schedule is to:

 Continue prednisolone 15 mg each day until symptoms are fully controlled (usually 3 weeks), then

 Reduce the dose to 12.5 mg each day for 3 weeks, then

 Reduce the dose to 10 mg each day for 4–6 weeks, then

 Reduce the dose by 1 mg every 4–8 weeks until treatment is stopped.

Scenario: Management | Management | Polymyalgia rheumatica | CKS | NICE

It’s the math.

Minimum

15 mg for 3 weeks, 12.5 mg for 3 weeks, 10 mg for 4 weeks, 9 mg for 4 weeks, 8 mg for 4 weeks, 7 mg for 4 weeks, 6 mg for 4 weeks, 5 mg for 4 weeks, 4 mg for 4 weeks, 3 mg for 4 weeks, 2 mg for 4 weeks, 1 mg for 4 weeks

Total 46 weeks.

Maximum

15 mg for 3 weeks, 12.5 mg for 3 weeks, 10 mg for 6 weeks, 9 mg for 8 weeks, 8 mg for 8 weeks, 7 mg for 8 weeks, 6 mg for 8 weeks, 5 mg for 8 weeks, 4 mg for 8 weeks, 3 mg for 8 weeks, 2 mg for 8 weeks, 1 mg for 8 weeks

Total: 84 weeks

This, ‘suggested’, presented as default, is not merely the 2 years people’s rheumies tell them but the statement PMR can be – should be – done and dusted in under a year or 1.615 years at most.

I understand we here are an atypical selection and there are many many people with PMR not here whose disease might indeed obediently follow a line on a graph but is there actually any evidence for the 46 weeks?

[PMRpro Ambassador]

Not that I know of.

[Mayadill in reply to PMRpro]

Oh shock oh horror. isn't there an old fairytale, people being put in a box and the bits that don't fit being chopped off. Just wondering how many PMR patients don't fit this pleasing fantasy.

[PMRpro Ambassador in reply to Mayadill]

Most of them!!!!!

[Mayadill]

I read the page and I know what it sounds like to me and that's even worse: a cure. Take 2 Amoxicillin tds for two weeks and that's that sorted. Can they possibly believe that when the last 1 mg tab is swallowed the PMR will have vanished in a puff of smoke. Of course not so why merrily give that impression. I read all the pages.

Goals

To support primary healthcare professionals to:

Make a diagnosis of polymyalgia rheumatica.

Control symptoms of polymyalgia rheumatica.

Nowhere does it say there is no cure.

[Suetum]

6 years later and was down to 1 when whoosh I had a flare!!!

[Meggsy in reply to Suetum]

5 years - 1/2mg - flare!

[9lives]

I’m 7 years now and at 1 mg but still the odd flair whilst trying to reduce!!

[Lochy]

I’ve got everything crossed……..7 years currently at 1.5 🤞