Thinks it’s a flare, what do I do

[BlueHog]

Female age 66 in UK, diagnosed PMR July 2022, started on 30mg pred and steadily tapering to 5mg. No problems until 2 weeks ago with pain in hips and now shoulders returning. Diagnosed with high blood pressure at this time and on meds. Being reviewed tomorrow at Cardiac clinic due to past intermittent chest pain. Can a flare cause blood pressure to rise? What dose of pred should I take now, for how long? Sorry to ask as I know there’s info on this amazing site but I cannot easily find it. Paracetamol not helping so pretty sure it’s my first flare. Feeling despondent but keen to get it under control. Thank you.

[PMRpro Ambassador]

How long have you been on your current dose? It sounds as if it is too low - you need to go back to the previous dose you were good at.

Some people develop raised BP because the blood vessels are narrowed with the inflammation. But ongoing pain can also cause raised BP. And of course, it COULD be something else since you are being reviewed by Cardiology.

The protocol for a flare is to add 5mg to the dose where it occurred for up to a week or so and drop back to the dose you were last good at. However, since you are at cardiology tomorrow I would just go back to the previous good dose until after the appointment - that may even be enough. And I would ask your doctor about the flare.

[BlueHog in reply to PMRpro]

Thank you for very helpful reply. Tapered to 5.5mg November 20, then 5.0mg January 15. Think I have just spotted the problem! Should have read my own records of doses. Was fine on 5.5mg. I am slowly reducing by 0.5mg every 2 months but probably need to go slower.

[PMRpro Ambassador in reply to BlueHog]

Doesn't matter how slowly you go - nothing will get you past the lowest effective dose - the lowest dose that gives the same symptom relief the starting dose did and that is what you are aiming for by titrating the dose in small steps.

That is about the right time scale for the 5 to show it isn't QUITE enough. If you are lucky going back to 5,5mg will be enough but if not a few days of 10mg and back to 5,5 should do the trick. That is the dose you need at the moment - it doesn't mean you won't get lower, just not yet.

[BlueHog in reply to PMRpro]

You are very reassuring with advice and information. I am so grateful. Thank you 😊

[DorsetLady PMRGCAuk volunteer]

This contains usual advice for dealing with a flare -

healthunlocked.com/pmrgcauk...

..and maybe employ one of slower tapering plans we always talk about and only reduce by 0.5mg a time -

healthunlocked.com/pmrgcauk...

[Caulkhead63]

Paracetamol didn't help at all paracetamol and codeine helped better but don't take them for to many days in a row