Flare or adrenal insufficiency.

[Richard170356]

I’ve been tapering slowly using the DSNS method and am currently going from 7mg to 6mg. I feel a bit of discomfort especially in bed in the morning and seem to have a stiff neck all the time. I can still function fairly well although I do feel tired after doing anything. Do you think this is due to too low dose of prednisolone or adrenal insufficiency? Any comments would be appreciated.

[SnazzyD]

It’s a tricky time and it can be difficult to tell what is what. Presumably you have checked that your mattress or pillow isn’t getting a bit long in the tooth or that your needs have changed. Looking at neck ‘housekeeping’ particularly the sternocleidomastoid muscles. Have a read of this this is new to you

healthline.com/health/stern...

You can upset these neck muscles with poor posture from stress or bad habits that creep in, repetitive upper body actions for example.

Adrenally speaking this dose level can be a bit tricky for some because it is still a bit too high for the adrenal axis to be triggered into action but it is too low to give you all the corticosteroid that you need to keep your lights on daily. The only way is to get past this stage by reducing but doing very slowly so you don’t have an adrenal crisis. 0.5mg drops over at least 4 . I did anything from 4-14 weeks and the lower I got the slower I got. You can feel wiped out by not a lot or nothing at all.

It might be a flare brewing but checking the basics might be the only thing you can do right now if it isn’t obvious. Some might try going back to where they were comfortable to see if makes any difference. That can be good for PMR but for adrenal function it puts off the evil moment of challenging the body to start to make its own cortisol.

[DorsetLady PMRGCAuk volunteer]

Could be a bit of both…or SnazzyD has said something else,

Perhaps back to 7mg for now -and then reduce by only 0.5mg a time … smaller steps will help both PMR and adrenals

[PMRpro Ambassador]

I suspect the only option may be to stick where you are and see what happens. If it is a flare then the niggles are likely to worsen but you would hope that if it is adrenals they will improve slowly.

[Bcol]

Hi Richard, just a thought to add to the others. As your pain is in the early mornings have you thought about taking your Pred at the optimal time of around 02:00 - 02:30 ish, that way it gets into your system before the nasties come out to play at around 04:30.