Advice please on flare and pred

[Markandevie]

I have been tapering down very slowly and was on 8mg but feel I may have done too much as my left shoulder and less so on right started to hurt. Two days on and the pain got worse so upped the pred to 12 and a little better so now been on 15mg for 2 days and pain much better. My question. How long do I stay on 15mg before dropping down....and by how much? Will I need to taper slowly again or can I try to drop to 10mg for example? So disappointing having to increase as things were going so well. Any advice would be great. Thank you

[SnazzyD]

Hello, when you say you have done too much, do you mean too much activity?

[Markandevie in reply to SnazzyD]

yes, i think so. maybe stretching too much or lifting. I think i will hang on to 15 then reduce to 10 and see how it goes. How long is recommended to increase pred and then to drop say 5mg without any issues?

[SnazzyD in reply to Markandevie]

If you can look back and see a recent period where you did unusual movements or repetitive strain of some sort, even sitting or standing for an unusually long time, or peeling 5kg of potatoes can cause muscle soreness. If it precedes the symptoms by a few days I would think about delayed muscle soreness (DOMS). I didn’t have PMR, only GCA, but plenty of Pred. I always tried rest and paracetamol or even a single dose of ibuprofen as it doesn’t necessarily mean it’s a flare. It usually goes in a few days to a week unless you’ve really tweaked something. Increasing Pred hasn’t been the answer. Which it is, is a bit of detective work and knowing your body and your tell tale signs of an actual flare.

[DorsetLady PMRGCAuk volunteer]

This link contains usual advice for flares - and you may need to go back to 9mg rather than 8mg - really depends what caused flare. 8mg being too low a dose.. or you overdoing things and it being a temporary blip.

healthunlocked.com/pmrgcauk...

[Markandevie in reply to DorsetLady]

thank you I will take a look now.

[Markandevie in reply to DorsetLady]

I have just read the advice and very helpful I must say. How long is safe for me to keep on 15mg before dropping to 10mg or 9mg? Thank you

[DorsetLady PMRGCAuk volunteer in reply to Markandevie]

You can stay on the increased dose for up to 14 days without impacting on drop back down. Any longer -and you may need to stagger it a bit more -say to 12,5mg for a week, then 10mg for a month..before restarting taper proper.

Hopefully 14 days will be enough.

[PMRpro Ambassador]

I'd say treat it as a flare plus DOMS, go back to 10mg and taper slowly again ONCE THE POTENTIAL INJURY HAS HEALED! Pred won't cure injury pain, paracetamol might help the DOMS but you need to find a balance.

And next time - spread whatever it was you were doing over a much longer time!