I’m an active 77 year old and looking for advice and tips please. After months of being uncomfortable particularly neck and shoulders but with no inflammatory markers the pain moved to hip girdle and thighs with extreme pain trying to get out of bed and function until full of ibuprofen and Paracetemol. Visited doctor again who thought all my ham string and back muscles were overly tight! Fortunately he redid blood tests and rang me last Friday to say CRP was 63 and various others showed inflammation so started me on 15mg Prednisolone to be taken with breakfast. So started on Friday 6th October and on Saturday got out of bed with little difficulty. And having walked the dog etc felt so much better. And totally pain free later in the day and all evening.
However there is still quite a degree of discomfort and stiffness first thing in the morning and I reckon it begins at about 03.00 am and takes at least 1.5 hours to wear off after rising. So my question really is in three parts.
1 is the dosage of 15 mg insufficient.
2 does the Prednisolone only stay in your system for about 19 to 20 hours - if so what do people recommend to fill the time gap before next dose kicks in?
3 is there a better time to take the meds to avoid such morning stiffness?
Any advice would be very welcome - like others very difficult to speak to my Doctor - a very small but busy Practice so always busy.
Look forward to your replies - thank you.
Tricia
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It should cover your questions - but you may need to give the Pred a little more time to work correctly….. for some it works within hours, but for it others it does take a bit longer…
The inflammatory substances are shed in the body at about 4-4,30 am - which partly accounts for the early morning stiffness, The optimal time to take prednisolone is at about 3am (2am for prednisone as it must be processed by the liver to be active) - this timing allows the peak level in the blood to be by 4am so that the inflammatory substances are stopped from having an effect before they even start. That is one way of improving the morning stiffness if you can be bothered to wake up at 2-3am to take the tablets! The splitting I describe below will achieve a similar result but you can choose the time you take the pills.
The antiinflammatory effect of pred lasts from 12-36 hours depending on the person. For the majority that means the pain relief is sustained over the full 24 hours until the next daily dose is due or the discomfort starts overnight and doesn't bother them if it isn't too bad. If it doesn't, it may not mean the dose is too low but that splitting it a bit will extend the antiinflammatory effect to the 24 hours. Usually suggested is about 2/3 of the total dose in the morning and the rest sufficiently later to bring the effect to the desired duration: so 10mg in the morning, the other 5mg maybe about lunchtime or a bit later. You have to try what works best for you.
It is however still very early days - there is a level of accumulated inflammation around the joints that must dissipate and that can take a few weeks. While that is still present, the effect of the morning batch of inflammatory substances is on top of that left-over inflammation. Once that is gone, the baseline is lower. I had hip bursitis and it was a few months before that was gone entirely.
Thank you - that is so helpful - I think I will maybe try the split dose. Yes I realise it is early days. As my title suggests I play golf and I am off the Spain on Sunday to play probably with quite early tee times so it would be really great to get things moving as early as possible!
Enjoy your golf-but don’t push yourself too hard. You have a serious illness that is still there no matter how well the Pred is working -and that only working on the inflammation side of things.
Thank you - i will be mindful and careful - if i have to stop/have a buggy whatever i Will - just sad that the weather is not great next week where our group are golfing s0 maybe cant just chill in the pool and sun..
Buggy sounds a very good idea ……sure you’ll still enjoy! Whereabouts you going , been in holiday villas close to a few golf courses [me not playing - my son and his FIL] over a few years…when grandkids were younger and we went as a family…
Careful with golf - seriously consider a buggy and try not to carry your bag. Keep the energy and ability to actually play the game. PMR goes for shoulders and hips - and repetitive actions can be poison. We'd like to think you will enjoy being there!
Thank you - certainly not carrying my bag - never do. I’m sure I will enjoy it - even just for the company - golf secondary - health is primary - I guess I’m not used to thinking I have something that might last years - always been a little gung-ho! And this as with most seemed to come out of the blue - albeit I’ve been experiencing aches and pains since June. I have a Jack Russell/cairn X who has been hell bent on escaping for the last 2 years so very stressful and lots of wiring, stapling, contortioning- I blame her!
I actually take my steroids at 2am in the morning with a piece of hard cheese (usually Comté which I love!). It seems to have stopped the morning stiffness.
Hi Piglette - cute name! Thank you I am often awake in the early hours so it sounds a good idea - I also like Comte but not sure at 2am! Much appreciated.
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