Flare Protocol

[Skier321]

I just spent a month at 2.5 mg prednisone and was going to 2 mg when I started to notice more stiffness in my right wrist, lower back, shoulders and neck. This has gotten progressively worse over the last couple of weeks. Four days ago in went to 5 mg for two days and the last two days I went to 8 mgs. I am pain and stiffness free now. I realize that I can stay at 8mg for about 1 to 2 weeks then drop back down to 3 or 2.5 mgs. My question is: if I am symptom free do I need to wait the 1 to 2 weeks before lowering back to 3mgs? Have I washed away the excess inflammation? Your wisdom is greatly appreciated.

[DorsetLady PMRGCAuk volunteer]

Have I washed away the excess inflammation?

Who knows…. but the longer you stay on the increased dose just to make sure is better -in my opinion.

I usually suggest 7-10 days … and as you are approaching 6 days in total, then 4 more days on 8mg is no great shakes in the great scheme of things.

But as ever, it’s your choice.

[Skier321 in reply to DorsetLady]

Thank you for your prompt reply. I was just concerned about the Adrenal glands as they have been getting used to working now since I went below about 7mgs. I was wondering if going to 8 mgs will slow them down again.

[DorsetLady PMRGCAuk volunteer in reply to Skier321]

Not when you’re only on the higher dose for such a short time….

[PMRpro Ambassador in reply to Skier321]

That's why the max is 10-14 days - longer than that and it might have an effect but the short time shouldn't.

[Skier321 in reply to PMRpro]

Thank you for clarifying this for me. All the best

[calibriel in reply to DorsetLady]

Thank you. Dealing with a probable flare at the moment. I have got a note of these things, but always good to have a reminder

[Polygolfer]

hello Skier! I’m a skier too, hence we have this amazing hobby in common and I might be of some use to you.

One of the interesting learnings I had when I was tapering down, was that at lower doses, old complaints such as arthritic wrists and dried out discs in the lower back start feeling sore and/or stiff again. Whereas that might or might not be a flare, or a return of pmr type inflammation, I found that in my case daily stretching and exercising the joints and muscles, even if just lightly, was beneficial. Blood circulates and irrigates affected tissues and hence can help mitigate stiffness and pain, especially if you are used to doing exercises or staying fit. It might have exactly the opposite effect for those who are not normally exercising as it will stress muscles and joints, but not if you are and have always been quite active.

Again, it’s different for every person and the best approach is always to give things a try and see what works for you and also to discuss it with your doctor.

[Skier321 in reply to Polygolfer]

Thank you for your thoughts. I am also a golfer. I am in good shape for my age and do regular exercises. However I will try more specific exercises

[Polygolfer]

Yes, generic weight, aerobic and stretching routines are excellent but focussed stuff is also helpful. For instance, if you have shoulder complaints, and assuming your doctor is supportive, there are several shoulder rotation exercises that irrigate the joints and keep everything ticking over nicely. The steroids do take away some that chronic ‘older’ pain so weaning yourself off the steroids might unfortunately involve re-acquainting yourself with some of those old pains and discomforts again. To my mind much better and healthier than resorting to drugs but still you and your doctor will now best how to proceed.