Pains in night

[Daffodilia]

For first time since started pred for PMR in 2018 I am starting to get pains in legs - arms and shoulders in the night - on 6 mg - not doing extra any exercise to normal - I am ok in the day - any ideas why please?

[PMRpro Ambassador]

Probably because you should never be tapering relentlessly to zero, you are tapering to find the lowest effective dose, the lowest dose that gives the same relief as the starting dose did. You do that by tapering until symptoms start to reappear and then you go back to the previous dose that worked well. It is also called titration - just like in chemistry at school. This is the way they take account of all the different aspects, different patient and response to pred, disease activity, all sorts of things. 6mg is slightly too low a lose in the longer term, a little bit of inflammation isn't being mopped up each day and is building up to a level that causes symptoms. Pred hasn't cured anything, it is a management strategy to combat the daily dose of inflammation that is created each morning as long as the underlying autoimmune cause of the inflammation in PMR is active - which in some cases can be years.

If it has only just started then maybe going straight back to your last dose may be enough but the usual advice for dealing with a flare is to add 5mg to the dose where you flared for a week or so until the symptoms have gone again and then drop back to the last dose you were good at.

[SheffieldJane]

Any stress or vaccines? I have reacted badly to the Covid booster and the the flu jab for the first time recently. Or as PMRPro explains, this could have been building for some time.

[Daffodilia in reply to SheffieldJane]

May be vax