Is this a flare

[Clucket]

Hello everyone. I am hoping for advice on whether I am actually having a flare or not.

I tried to reduce from 4 to 3.75. but after increasing neck aches and other things I went back to 4 after about 8 days. I have only been reducing by .25mg for at least a year, as I could not manage larger decreases.

After 8 days of being on 4mg, the neck problems are still there, plus random other niggles that weren't there before my decrease eg sporadic thigh muscle pain or discomfort on walking and slight back pain, where I have some arthritis.

They are relatively mild, but the neck problems are as though I have been overdoing it, though I haven't qnd have actually cut back on using my arms in a way that may make my neck hurt.

In the morning when I get up it all feels OK, but as the day progresses, it slowly starts to ache more and doesn't go away.

I Do not know whether i should expect the original pmr aches and pains as I get to lower doses, or Is it a sign that the dose is now too low.

Also Should I also expect to feel arthritic and spondylitis changes in my spine more as the dose gets low.

I have been on pred for 3 years now, and for the last 18 months i would say my neck had stopped having the pmr ache at the back, though it has often been painful on the rt side due to spondylitis.

Is this a flare though all the symptoms are relatively mild by comparison with what they have been in the past.

I do not know whether to try and ride it out, and stick to 4mg which was OK before, but doesn't seem to be now, In the hope that it is too mild to be a flare and it will settle down with time.

If it is a flare, should I go up adding 5mg and then back down to 4 or 4.25?

How does one not have this keep happening when trying to reduce at the lower dose levels, as it becomes a larger % decrease.Thanks in advance for your replies

[DorsetLady PMRGCAuk volunteer]

This explains the difference between a flare and steroid withdrawal and how to deal with a flare-

healthunlocked.com/pmrgcauk... - but at your level it could be drdnsl stuttering -

healthunlocked.com/pmrgcauk...

If you keep flaring at the same dose, then perhaps that is telling you that is your lowest dose for the time being - won’t always be… but is for now… and no matter how small a dose you reduce by or how slow you taper, if you go below the dose you need, you go below it… end of…

.. and many of us discover that as you get to lower doses, then the pain from other health issues resurface. - but ordinary painkillers may help - have you tried anything?

[Clucket in reply to DorsetLady]

I had the neck problem for a year before the pmr and pain killers never worked on it then, or since. The thigh muscle problem is an occasional not consistent pain, so would be hard to take painkillers for or judge whether they had had any effect. I will give paracetamol another go now and see if they have any effect on my neck today. I am still confused as to if I need to increase the pred dose to get back to how I felt on 4mg before I tried to decrease .

[DorsetLady PMRGCAuk volunteer in reply to Clucket]

I would follow the advice in link - so add 5mg to the 4mg you’ve been on for last 8 days as that’s obviously not enough if it is PMR]. Try it for 7 days, and see what happens - hopefully that increase should be enough. If it is, then drop back to 4mg… and stay there for a least a month and get over the stress of Christmas etc.

If it doesn’t work, then it’s probably not PMR so you’ll need to find out what it is by visiting GP…

[Clucket in reply to DorsetLady]

If I resolve the stress , will 4mg become sufficient without having to increase by 5mg then decrease again?

[DorsetLady PMRGCAuk volunteer in reply to Clucket]

Not quite as easy as that…. but it will help in the longer run, and as PMRpro has said, if you don’t address it now with an higher dose, it will probably get worse, and then you’ll need even more Pred.

[PMRpro Ambassador in reply to Clucket]

Maybe - maybe not. But if you currently let in a flare because you don't deal with it NOW. you may end up needing more than a short term of adding 5mg.

[PMRpro Ambassador]

Flare symptoms are likely to be less at the start - leave it and they will get worse.

The idea is that you take enough pred to prevent the original PMR symptoms returning - so if they do reappear you have gone to too low a dose. And you aren't reducing relentlessly to zero - you are looking for the lowest EFFECTIVE dose. That is a balance between too much pred and too little pred to manage the inflammation.

[Clucket]

Thanks yet again wonderful ladies for your support and wisdom. Much appreciated.