reducing prednisone

[Gooner12]

I am 10 days into taking Prednisone. I started on 15mg and was increased to 25mg after 5 days as still in pain. I have been advised to started reducing to 20mg after 10 days at 25mg.

this morning whilst I still have some pain I am feeling much better.

my questions are

1. Should I expect to be completely pain free when I start reducing or do I just go ahead and reduce?

2. should I go to 20mg or use the 10% rule and how long before reducing again.?

3. If when I do reduce, pain returns do I return to previous dosage

interested in your experience

[piglette]

There are a lucky few who have no pain at all, but provided you have at least 70% pain reduction that should suffice.

I feel that giving it four weeks at the beginning before reducing is a good idea, but you are on quite a high dose. I suppose it really is a matter of trying it. Others may have better ideas.

Again some people can manage a 5mg drop at high dosages although if you are like me you can’t! When you first reduce you may get steroid reduction pain which can last two or three days. This goes away. If you have reduced too much it does not show for over a week or two and it does not go away, so you need to increase again.

[Gooner12 in reply to piglette]

What is steroid reduction pain? How does it differ?

[DorsetLady PMRGCAuk volunteer in reply to Gooner12]

What is steroid reduction pain?

what we refer to as steroid withdrawal pain - and basically your body getting used to the reduction in medication..

STEROID WITHDRAWAL (or body getting used to new lower dose) usually shows immediately new dose is taken - and lasts between 2-5 days, but should then disappear.

It varies from a general feeling of being off colour to a return of symptoms pre diagnosis. For some the effects can be eased by paracetamol. It’s one reason why the various slow tapering methods were devised.

Full link explaining difference between that and a flare -

healthunlocked.com/pmrgcauk...

[piglette in reply to Gooner12]

Sorry I should have said steroid withdrawal, my brain is going! Luckily DorsetLady understood my garbled reply.

[DorsetLady PMRGCAuk volunteer in reply to piglette]

Well after all these years.....😏.. we all understand garble - and very often partake in it,...

[DorsetLady PMRGCAuk volunteer]

You have another 5days before you need to make a decision.

So see how you are then -and then either stay another week if you still have some pain

or

If you feel okay then down to 22.5mg for another 3-4 weeks, then to 20mg for same period providing no return of symptoms.

Come back to us then -and depending on how you are we'll either suggest a 2.5mg or a 1mg drop from then on.

[Gooner12 in reply to DorsetLady]

Thanks for the advice.

[Charlie1boy]

Yes, I agree absolutely with what DorsetLady advises. I feel it’s really important to get your pmr under control before trying to reduce. My mantra was never to try reducing if I could identify any pmr pains, and I think that’s really important at the start of your journey.

Good luck.

[PMRpro Ambassador]

The 70% improvement in a few days is an indicator that this is PMR rather than an inflammatory arthritis more than a sign "this is enough". I personally think that the starting dose, whatever was needed, should be used for at least 4 weeks, used to be 4-6 weeks was recommended, until the symptoms were resolved to a stable level and the blood markers were well on their way down to normal. But then they got panickstricken about pred.

In our experience, getting things well controlled before starting to taper and then using the approx. 10% of the current dose rule, results in fewer unnecessary flares and returning to higher doses and almost certainly means using LESS pred than rushing at reductions whether the patient is ready for it or not. The level of relief you get with that starting dose is your guide. You may not be totally pain-free but you should never feel worse at the end of a taper step than you did at the start.