Managing a Flare

[MegfromOz]

I've tried to work my way through this latest flare but am now looking for specific advice.

I have been tapering slowly and got to 12.5 pred and was on that dose for 3 weeks and looking to stay there another week when I had pain in buttocks, legs, hips and upper arms. Previously the pain had been very very mild.

I thought it was a flare so upped my dose to 14.5 thinking this would work , have been at 14.5 for 4 days and not noticing much of an improvement.

Should I go up 5 mg to 17.5 for 14 days?

Can I then drop back to 13.5 where I was comfortable without tapering?

Of course, like all of us, I worry about upping the pred but understand that I need to up it in some way.

Thoughts from the experts??

[DorsetLady PMRGCAuk volunteer]

Usual advice for flares-

healthunlocked.com/pmrgcauk...

As you have found out an increase of less than 5mg rarely works [sometimes, and might have if you’d acted quicker, but not once the inflammation been allowed to build up].

And yes you should be able to drop back to 13.5mg - but if you’re not 100% confident in that- you can do it in 2 steps - with 3-4 days at the midway point..

Good luck…

[MegfromOz in reply to DorsetLady]

Thanks, I started on 17.5 today and will try for 7 days and if necessary 14 then I will drop back to 13.5 but will do it in two steps as you suggested

Thanks for your support

[PMRpro Ambassador]

Ditto to DL's reply,

Maybe you need 13mg at present rather than the 12,5mg where you noticed the problem. So if the flare protocol works - go very gingerly in the next attempt.

[MegfromOz]

Thanks I am now following Dorset Lady suggestings and as you say will go very gingerly. I thought I was going gingerly by taking 4 weeks to go 1mg but lesson learnt.

Thanks for your help

[PMRpro Ambassador in reply to MegfromOz]

It is for some people. But if 13.5mg is what your body needs to manage the inflammation this week - that is what it needs. And early on it is going to be more than it will be later. You will get lower - just not yet.

Did you do chemistry at school? Did you learn titration? You do it by going in bigger steps at first until the next addition turns the colour. Then you repeat that stage in very small steps to identify the exact turning point. That is what you have just done - but the trick is to realise that is what you did. Now you know the approximate range FOR NOW. And you may have to do it again and again as you get lower - but it is important not to allow a flare to get hold.

[MegfromOz in reply to PMRpro]

Thanks