Flare protocol and how to manage it.

[waltztherapy]

Flare protocol and how to manage it.I was doing so well on 5mg prednisolone when in the 6th week, a horrid flare hit me affecting my mobility like never before. I added 3mg to make it 8 in total, but that wasn't enough, so upped it by the recommended 5 mg, making the total 10 mg. I stayed with 10mg for my short 5 night holiday so the total is nearing 10 days, mostly effective until today when stiffness is troublesome. May I ask your advice on how long I should stay on 10mg, and can I go back to 6mg, ie above the last effective dose before the flare, or should I make a staged reduction. I feel as though I've lost my way now and would be grateful for any guidance here please.

Kind regards and many thanks.

[piglette]

The normal suggestion is to up by 5mg for a maximum of a couple of weeks then drop back down again in a couple of drops. However if you are still in pain don’t drop back, as the PMR will come back and bite you. You will need a slower taper then though. I wonder what triggered it as flares tend to happen a week or two after reducing.

[DorsetLady PMRGCAuk volunteer]

I’d give the 10mg another 5 days and hope that’s enough to sort things out.. but have to say if it seems less effective now than it did at beginning I do wonder.

Suggest you do as little possible over the next few days to really give the Pred a chance to work.

Hopefully you should be able to drop down to 6mg -but you’ll have to see.

If it doesn’t work out as planned you may need more input…either from us or medics.

[waltztherapy in reply to DorsetLady]

Thankyou so much DL. Your advice sounds logical. I did spend my holiday dashing about seeing friends in between dance classes, plus a four hour congested drive home yesterday. Your suggestion of doing as little as possible over the next few days sound wonderful.Bless you for your use words. Xx

[DorsetLady PMRGCAuk volunteer in reply to waltztherapy]

That’s probably the reason then! So rest for few days -the catch up for washing etc can wait… 🙄

[waltztherapy in reply to DorsetLady]

Aw you're so right of course. Thankyou wise lady xx

[PMRpro Ambassador in reply to waltztherapy]

I think you have answered your question - even with more pred that is a recipe for feeling as you do. Often it will settle with rest and ordinary painkillers so try that first.

[waltztherapy in reply to PMRpro]

Thankyou PMR. It's so good to have this kind of advice. I am beginning to realise that not pushing oneself even when feeling good, is very important, in addition to giving in to hours of sleep when the brick wall of fatigue strikes. X

[GrandmaPirate]

When I came down from 20mg to 2mg/day, feeling well at 2mg and therefore instructed to start to take 2-3 days a week 1 mg/day, just at the time I got my first Covid vaccination, I got a terrible flare. My rheumy instructed me to switch again to 8 mg/day, which was effective and then to reduce very very slowly back to 2mg/day. It took me longer than the first time, but better slow than too fast she said. So have a look at your daily intake the first time and do the same reduction or even slower. That is my suggestion. Good luck and hope you feel well again soon.

[waltztherapy in reply to GrandmaPirate]

Aw, thankyou for your kind note GrandmaPirate. It's so helpful to learn of other's experiences with sudden flares at the lower levels. The whole tapering thing is a bit of a minefield it seems.