Is it normal or a flare??

[Fishtacoqueen]

Hi,

I’m fairly new to the world of PMR and have found this site invaluable for information and support. I was diagnosed in May this year, started on 15 mg and relief from all pain was within hours. Reduced to 12.5 after a month and then after another month to 10mg which I am currently on. Now I am feeling some some mild discomfort and stiffness in my neck usually just before I get out of bed in the morning. With movement it tends to go away. Everything else is just fine. I can walk over 5 k a day and continue to play golf with no issues. My question is if it is normal and acceptable to have some discomfort even while taking Prednisone, or if it is a reaction to reducing it or if this is considered a flare? Thanks!

[PMRpro Ambassador]

Hi and welcome!

Early morning stiffness and discomfort is to be expected to some extent since the inflammatory substances are shed in the body about 4-4.30 am and if you are borderline on dose then you may feel it until the new day's dose kicks in. A flare would be if it DIDN'T go away with the daily dose or movement and you now need to keep an eye on things to be sure you don't feel worse at the end of a reduction step than you did at the start, You also need to slow down - 2.5mg at a time is OK down to 10mg (providing it works, it doesn't always) but now not more than 1mg at a time and possibly even 1/2mg if you start to have problems.

The antiinflammatory effect of pred lasts 12-36 hours and if you are at the lower end of the time span, then the symptoms may be felt before the next daily dose is due. If that happens splitting the dose may make a big difference. Usual split is 2/3 in the morning, the rest later enough in the day to extend the effect to 24+ hours.

[Fishtacoqueen in reply to PMRpro]

Thanks for the clear information and advice. Exactly what I was trying to understand and glad to hear it as I was a bit confused about what a flare presented as. My GP had indicated that I will be going down 1 mg. or less each month from my 10 mg now.

[DorsetLady PMRGCAuk volunteer in reply to Fishtacoqueen]

This gives more info about a flare -

healthunlocked.com/pmrgcauk...

..and yes slow down on taper from now on…

[Animalover65 in reply to DorsetLady]

Thank you for this article, it's very helpful. Am I right in thinking that in healthy people there is a small amount of inflammation that gets cleared away ?

[DorsetLady PMRGCAuk volunteer in reply to Animalover65]

The inflammation in “healthy” people is due to many things - can be a simple as stubbing your toe, to a cold, to a major operation -and it’s the body’s own mechanism to help cure itself. .. and it usually only produces as much as is required.

Inflammation from PMR or GCA and some other illnesses is different -it’s produced by the illness and does not “stop” so long as the illness is active - so you need steroids or some other drug to control it.

[Animalover65 in reply to DorsetLady]

Yes its good that the immune system is good at doing its job generally. I was thinking about how during sleep at certain times during the night there are happenings which help keep the brain healthy. And in a similar manner I was wondering if when a person who does not have PMR/GCA sleeps no inflammation is released at all during the 4.00am to 4.30 am slot. Sorry if I am over thinking things - might need a new hobby!

[PMRpro Ambassador in reply to Animalover65]

It isn't inflammation that is released - it is substances that may produce inflammation because they have a function in normal running of the body as a "machine".

medcraveonline.com/MOJI/cyt....

The simple summary is right at the end, in the Conclusion:

"In conclusion, cytokines are ubiquitous molecules which act as key messengers for and between immune cells and help to maintain a delicate and intricate balance in the immune system. Cytokines affect nearly every biological process viz. embryonic development, disease pathogenesis, non-specific response to infection, specific response to antigen, changes in cognitive functions and progression of the degenerative processes of aging. They are also involved in stem cell differentiation, vaccine efficacy and allograft rejection. Such regulation of immune homeostasis is crucial for health and disease, and disruption of this balance results in many chronic pathophysiological states. Thus, it is imperative that therapeutic targeting of cytokine pathways holds great promises for patients suffering from several intractable chronic diseases.

[Animalover65 in reply to PMRpro]

Thank you PMRpro got it. I never thought that having this strange condition would challenge me to understand such complex goings on! And find such knowledgeable, supportive friends.!

[PMRpro Ambassador in reply to Animalover65]

It's the sort of thing I read for fun ...

[Animalover65 in reply to PMRpro]

Glad you do for the rest of us. Does that exclude watching progs like Corrie and Eastenders?

[PMRpro Ambassador in reply to Animalover65]

I have never seen either ever!!!! Despite my mother-in-law wanting to discuss them over tea!!!!

[Animalover65 in reply to PMRpro]

Put her in touch! LOL

[PMRpro Ambassador in reply to Animalover65]

Got a handy medium? Been dead 30 years or so!

[Animalover65 in reply to PMRpro]

I wondered LOL Those programmes have been running for a long time!

[DorsetLady PMRGCAuk volunteer in reply to Animalover65]

PMRpro has given you better reply than I ever could -and yes you may need a new hobby! 😊

[Animalover65 in reply to DorsetLady]

Thanks DorsetLady - I will try and find a good novel. LOL