Aches and pains PMR?

[Merryfield]

I have reduced methylpred to 4 mgs. Thought I was doing ok. Both shoulders hurt but with different exercises. My right buttock /hip has been very painful. None of these aches and pains impinge on range of motion but without ibuprofen. walking is a challenge. Pain in butt increasingly worse. Also have periodic lower lip and jaw numbness. Saw doc yesterday. Sed rate in 50s, up from 30s. It is clear that as I reduce steroids, inflammation marker goes up. So—question is, what level of methylpred should I go up to? I am not sure the aches and pains are a flare. Thanks for your thoughts. BTW, doc suggests going to 5 mgs. I am not sure that’s enough.

[PMRpro Ambassador]

They are a flare - the blood results show inflammation is increasing since they are accompanied by symptoms. Raised markers without symptoms could be something else. 50 for the sed rate is clearly raised but even being in the 30s would normally be considered raised. What is the lowest sed rate you have achieved and at what dose?

You aren't tapering relentlessly to zero come what may, you are looking for the lowest effective dose, the lowest dose that gives the same result as the starting dose did. What was the last dose where you felt that good? With pred we would say add 5mg to the dose where you flared for a week to 10 days and drop back to the last dose where you were good. So at least you need to add 4mg for a week or so - I would take 8mg for 7-10 days and then drop back down. If you were OK at 5mg. then that would be OK.

[Merryfield in reply to PMRpro]

Thank you. I started at 30 in 12/22. After that dose for a while, sed rate went from 128 down to 7. But it was in the 30s for two blood tests as I began to reduce. I guess I was pretty good at 15, but I don’t remember.

[PMRpro Ambassador in reply to Merryfield]

Then in my opinion, you should be aiming for a sed rate round about 10 and if it starts to creep up, you may well be at slightly too low a dose. It is likely to spike every now and again because it rises with any sort of inflammation or infection but if there is a general trend of the baseline rising - the first place to look is at the dose for PMR.