Prednisone reduction

[Seal49]

After reading so many stories and experiences by people trying to reduce, I feel alittle confused. I started reducing at 25 by 2.5 mg every 2 weeks and my Rheumatologist started me on methotrexate as he wanted me aff pred faster. I did methotrexate at 10 mg for 2 weeks, 15 mg for 2 weeks and will go to 20 this week where I'll stay. Rheumatologist says I have psoriatic arthritis and not PMR. I am reducing by 1 mg a week prednisone and got from 17 down to 12 and feeling OK. Is this because I definitely do not have PMR or because I'm taking methotrexate? will my adrenals start working if I get off prednisone and stay on methotrexate

[PMRpro Ambassador]

"I started reducing at 25 by 2.5 mg every 2 weeks and my Rheumatologist started me on methotrexate as he wanted me aff pred faster."

When on earth will they learn it doesn't work like that? If MTX worked for PMR they would use it from the start - they don't.

However - if he is correct that you don't have PMR but PsA, then methotrexate is the right medication to be on, rather than pred.

Even so, even with PMR you start with a dose that is higher than you are likely to need to clear out the inflammation and then you taper the pred dose (slowly, not as he was doing it) in a process called titration to find the lowest effective dose for YOU. So if the final dose you will need is low, you won't feel much unpleasant on the way down unless you try to go in too big steps.

I would say it is the other way round - you will get off pred if your adrenal glands start to work properly. You haven't been on pred very long, long enough to suppress adrenal function but the people who have problems tend to have been on it for at least a few years. I think you will probably have less trouble than most.

[Knitwits]

Hi

I have been on metro injectors 15mg for over a year. I was on 5mg pred at the start I am now on 3mg. I stay on the dose for three months then I will do alternate days of 3mg 2mg I have done this kind of tapering for a while and it is working for me. I am having problems with my adrenal gland not working.

[MiniSpec in reply to Knitwits]

Try doing alternate days of 3mg and 2.5mg, as this is a lower percentage of change, and it seems to make a difference to how successful the reduction is. Once you're established on 2.5mg per day, then do the alternate days with 2.5mg and 2.25mg to see how well that works. Again it's to do with the percentage of difference between the higher and lower dosages. The smaller the change the happier your body will be and the less likely you are to suffer any flares.

I recently went from 2.25mg per day to 2mg per day, but stupidly didn't do alternate days. Instead I just dropped from one to the other, and five days later I had to jump back up again to 3mg as I had severe pain and stiffness in my neck and shoulders. Next time I'll make sure to do alternate days when tapering, as well as keeping the amount of change as small as possible.

[DorsetLady PMRGCAuk volunteer in reply to MiniSpec]

Actually a slower taper is better for the body …many of us more experience folk aren’t keen on the alternate days approach… but if it suits you fair enough.

[MiniSpec in reply to DorsetLady]

I totally agree. My problem was that having been on 2.25mg for 7 weeks, on Sept 16th I dropped to 2mg every day without doing any alternative dosing. After 4 days I woke up with very painful neck and shoulders and it took me nearly 2 weeks going as high as 12mg per day to clear out the pain and stiffness, before dropping down to 3mg per day.

So next time I reduce my dosage, not only will it be 1/4mg per time, but I'll do alternate days as well, in order to easy my body down to the lower dose as slowly as I can. So, if going from 2.25mg to 2mg, I'll do say 3 days of 2.25mg followed by 1 day of 2mg, then after a couple of weeks of that I'll do 2 days of 2.25mg followed by 1 day of 2mg, and so on, until eventually I'm on 2mg every day.

If I start to feel any stiffness returning I hope I'll have more warning by doing the alternate days thing, than I got when I just dropped straight from 2.25mg to 2mg.

[DorsetLady PMRGCAuk volunteer in reply to MiniSpec]

Good luck…. It sometimes does become very difficult at such low doses..

[DorsetLady PMRGCAuk volunteer in reply to Knitwits]

I am having problems with my adrenal gland not working.

Then try a slower taper - a few to chose from here-

healthunlocked.com/pmrgcauk...

And dropping by only 1/2mg rather than 1mg a time…

[Seal49]

I understand that I may need t o slow down my reducing. I will stay at 12mg prednisone until next week and then try 11.5 for a week and then 11.0 until i am scheduled to see my Rheumatologist on 11/8 and let him know that I want to take the reducing slower. If I experience neck and shoulder pains I'll stop reducing.

[PMRpro Ambassador in reply to Seal49]

When we say slow down tapering - we mean to 1mg a MONTH. When you change dose every week your body never gets to settle down and it doesn't know where it is.

[Seal49 in reply to PMRpro]

Won't make my Rheumatologist happy when I see him on 11/8 but I will slow down more. Thanks. I really believe in your opinion.

[DorsetLady PMRGCAuk volunteer in reply to Seal49]

Not weekly - it can take 2 weeks [sometimes longer] to know the current dose is adequate - if you reduce before you know that it can be a recipe for disaster....

[Seal49 in reply to DorsetLady]

Won't make my Rheumatologist happy when I see him on 11/8 but I will slow down more. Thanks. I really believe in your opinion.

[DorsetLady PMRGCAuk volunteer in reply to Seal49]

It might not make your Rheumy happy, and I know that can make life difficult for you..but at the end of the day it’s your body and your illness - and you have to live with it day on day…. And as you are in the States you are paying him … or your insurance company is.. sometimes they seem to forget that.

[bonmaine in reply to DorsetLady]

A happy rheumy? Nah.