Authoritative source about flares

[papadapadoo]

I recently had a bad cold and developed considerable pain in the shoulders and arms. My taper had me at 8mg at that point, but to mitigate the pain I went up to 10mg for three days and that dealt with the small flare. My doctor told me afterwards that I should not adjust my dose without clearing it with him. This is all very well, but the pain peaked on Thursday and the doc works just a half day then and is off till Monday. It would be helpful to educate him about the value of a short-term increase in dose to deal with flares. I have learned from this forum how and why we do this, but of course he knows better. Does anyone have a reference for an authoritative (non-layperson) source to support this temporary increased dose?

[PMRpro Ambassador]

I do know of various rheumatologists who use the same approach. The easiest way to deal with it is to keep schtum. What the eye don't see, the heart don't grieve over...

[papadapadoo in reply to PMRpro]

Of course you're right, though it goes against my grain. This doctor, otherwise excellent for me, told me to go to 7.5mg after I had been stable at 10 for a month. Big flare, of course, and it rather undercut my confidence in him!

[PMRpro Ambassador in reply to papadapadoo]

He obviously hasn't done any reading about tapering pred, It is widely accepted that tapering - as opposed to reducing, they are 2 different things - should not be more than 10% of the current dose to reduce the risk of flares and steroid withdrawal. It is a fundamental misunderstanding of the disease and its management. But they are too arrogant to admit they might be wrong ...

[DorsetLady PMRGCAuk volunteer]

Para 8 and Figure 2 in the attached guidelines refer to relapses. However, if you have at least 2 relapses the recommendation is to add in MTX - so unless you want that, be a bit careful about what you wish for -

pmrgca.org.uk/wp-content/up...

[papadapadoo in reply to DorsetLady]

Just what I need! Thanks, Dorset Lady.

[Paulagcl]

I am new to PMR (six months) but had that same question. Many people do just what you did, temporarily increase the dose. I just did that yesterday, just .5 mg but it helped. My doctor said try a very small dose, that it is surprising how well that can work.

[Bertiebeagle]

I had a similar situation last Christmas - had a flare, obviously no doctor available to consult and didn’t feel I could leave it 4 days in the hope that I might speak to him in the post Christmas rush at the surgery. I increased the pred which was effective, spoke to the doctor eventually (later that week) to get advice on what next and he pretty much told me to get on with it (I’d made my bed …) and that I would have to start tapering all over again! Needless to say I followed the advice on here!

[PMRpro Ambassador in reply to Bertiebeagle]

It is a mistake they make a lot and I think it is the cause of many problems. If there is the sign of a flare they often tell patients to go back to the start which is totally unnecessary if it was due to overshooting the dose. It is a fundamental misunderstanding of the disease mechanism and how titration of the dose works.