Why is the pain and stiffness much worse in the morning

[RachelJDH]

I find that pain and stiffness lasts all morning but seems to improve if i have a rest after lunch. This does seem to have got worse since I reduced a paltry 1/2 mg to 10.5mg which i was determined to stick to but I have been so struggling to walk or get up the stairs in the morning for the last couple of months that yesterday i finally gave in and took 15mg to treat it like a flare. Ah the magic of Pred I am feeling much more mobile today - is it normal to be worse in the mornings - i take my pred with breakfast. Also how long would I take the increased dose before I can go back to 10.5 to avoid the many months of taper again. I have to say the pressure to get off Prednisolone which the doctors gaily handed out as the only treatment is very depressing and makes me feel like somehow I am failing - Pred is not a lifestyle choice.

[DorsetLady PMRGCAuk volunteer]

This link contains advice for dealing with a flare -

healthunlocked.com/pmrgcauk...

- and back to 11mg rather than 10.5mg. Never ignore a return of symptoms - it inevitably ends up being worse.

Maybe use one of the slower tapering plans we always recommend -

healthunlocked.com/pmrgcauk...

[RachelJDH in reply to DorsetLady]

Thank you DL. I couldn't find the link. I was on 11mg for months and it seemed such a small drop. X

[DorsetLady PMRGCAuk volunteer in reply to RachelJDH]

Unfortunately whether it’s small or not… if 11mg is what your PMR needs, it’s what it needs… pity some doctors don’t get that!

[RachelJDH]

The flare advice is excellent. I feel better reading it. I have had PMG for longer than I imagined and feel quite stuck - i think i may have to revisit MTX. I worry my grandchildren will be grown up before I have the energy to enjoy doing activities without having to rest before, during and after. Sorry to moan. Not everything can be resolved straight away. We are all grateful for your devotion to this site.

[PMRpro Ambassador]

It is normal for the stiffness to be worst in the morning - the new batch of inflammatory substances is shed in the body in the early morning, about 4 to 4,30am. The ideal time to take pred to avoid this is 2-3am so it is present ready to stop any inflammation becoming established, but the sooner you can take it after 4am may also help, less inflammation can be created in less time.

Another option when the antiinflammatory effect barely lasts 24 hours (it varies from 12-36 hours depending on the person) is to split the dose, taking about 2/3 in the morning and the rest sufficiently later to extend the effect to when the next daily dose is due.

And don't be led into thinking MTX has all the answers - the fatigue I experienced with MTX really crowded that with PMR and pred into the shadows!!! Remember that however you feel with the starting dose is how you should feel at lower doses - you shouldn't feel worse at the end of a taper step than you did at the start.

[RachelJDH]

Thank you I like to know the science it makes me feel calm - we are a science family as my daughter has a PhD in plant genetics and my beloved is an archaeologist (i get more interesting as i age!). I also found MTX made me very very tired and foggy but I only stayed on it for 6 weeks. It reminded me of when I had chemo many years previous and that didn't help, but perhaps I should try again. I was too scared to try Leflunomide.

[PMRpro Ambassador in reply to RachelJDH]

Have a daunder around the FAQs, lots of the background there.

By the way - if you want to reply to someone, make sure you click/tap on the Reply box attached to their comment, then they will be notified you replied to them. Otherwise only the author of the thread, DL and I are likely to see your reply as she and I actively follow all the threads - few others do.

[RachelJDH in reply to PMRpro]

Thank you. Will do x👍