Pred dose increase gradual or fast?

[sharpedge]

I am on a permanent dose of 6mg Pred for PMR. I still feel dodgy and if anything probably worsening. I want to try increasing my dose to 10mg to see if it makes any difference. Question is can I go straight to 10mg or should I increase gradually.

kind regards

[piglette]

You can go straight up to 10mg and also reduce back again, if you do it within two weeks. Although it is often better to do it in a couple of steps.

[sharpedge in reply to piglette]

Thank you, so straight up to 10 and then after two weeks max, straight back down to 6?

[DorsetLady PMRGCAuk volunteer]

If it's a flare - or you are treating it as such, then you can follow advice in this link - but it could also be adrenals struggling at that dose - so what do you mean by "feeling dodgy"

healthunlocked.com/pmrgcauk...

The problem for us is you don't have anything on your bio/profile to give any context of your question - so bit difficult to give a sensible answer,

[sharpedge in reply to DorsetLady]

I’m sorry I don’t have a detailed record of my condition, can’t remember the dates and details. Other than, first diagnosed with PMR about 10 - 15 years ago. Have been on Pred at various doses continuously. Now on 6mg for about two years I think. The pain/aching particularly in my shoulders has never gone away. My rheumatologist appointments seem to have gone down the drain. Male and 76. Also on Methotrexate 15mg jab once a week.

[DorsetLady PMRGCAuk volunteer in reply to sharpedge]

Okay - so sounds as if you have a strain of PMR that’s very persistent- but if the shoulder pain has never gone away is everyone certain is only PMR - and not something else added in?

The only problem with going up to 10mg for a short time and coming back down to, say 7mg rather than 6mg … you might end up in same situation.

As your Rheumy appointments seem to be few and far between, do you have a sensible GP you could discuss with? Sorry if that’s a silly query..😳

[sharpedge in reply to DorsetLady]

Thanks Dorset, you are probably right I will need to find a GP that’s sympathetic and hopefully knowledgeable.

I’ll let you know what happens.

Kind regards

[tangocharlie]

I'm also a long-timer, 13 years now. Now and then if I feel a flare coming on I increase my dose by 5 for about 5 days and that usually does the trick, I then go straight back down to the old dose. I should say for others reading this and worried I do it without taking advice that my GP knows and it's on my records that I'm 'reducing dose under guidance of rheumatology'. I've been doing this a long time and always tell my rheumatologist what I've done. She's learned a lot more about flares these last few years (not just from me, other patients) and how they can be totally random.

[sharpedge in reply to tangocharlie]

Thanks Tango, i think I’ll try that

[sharpedge in reply to tangocharlie]

Forgot to ask Tango, what is your normal dose?

[tangocharlie]

ATM I'm on 10 mg, stil high, but a year ago it was 22.5

[sharpedge in reply to tangocharlie]

Thanks Tango

[PMRpro Ambassador]

Go straight up, creeping up is a waste of time as you keep playing catchup.

But aching shoulders like that may be something else - back and shoulder muscles being tight or even in spasm can cause a lot of discomfort but increased oral pred doesn't necessarily help. A good assessment from a therapeutic or sports massage therapist might be a useful input.

[tangocharlie in reply to PMRpro]

I've been seeing physios for nearly a year now and they've not known anything useful for me, certainly nothing about inflammation or PMR and its manfestations. The only useful bit was a private physio who did some kind of electrical stimulation which helped with the back spasms. The others apart from the very last one didnt even pick up the GTB and that's only because I insisted he look at my leg which I was having to lift with my hands to get out of bed, not just my back. Two physios also failed to pick up my PMR in the early days too. So for me, I try increasing steroids first to rule out a flare. I did take a batch of the charity's leaflets down to the medical centre to give to the physios there and told them they can join for free as helathcare professionals! I don't think even the physio who passed on some general exercise tips at the last PMRGCAuk AGM knew any specifics about PMR, he certainly didn't mention it at all, just the polymyositis that the consultant (can't remember the name sorry, Hector?) was talking about.

[PMRpro Ambassador in reply to tangocharlie]

UK physios are pathetic. I've have had a couple who were brilliant at backs but they were both back sufferers themselves and knew exactly what was needed.

[suzy1959]

I think I have finally found a good physio! He is a sports specialist( ironic given my lack of mobility!). I have been seeing him over the last few years, especially after the joint replacements, but now I appear to have got rid of the PMR, he is helping me with the pain I am left with and giving me a very slow rehab plan.

I am choosing to hope that this will work!!

[PMRpro Ambassador in reply to suzy1959]

I've always found the sport specialist ones are very good. Maybe that's why they are good here since they ALL are into sports and a large proportion of their work is related to sport - everyone skis or does other winter sport and walk or bike up and down mountains in the summer!