Taper or flare?

[Oshmar]

Feeling a bit glum and derr brain . Under GP orders I have been reducing from 10 mg to 9 mg predictable, and definitely feeling an upsurge of symptoms. What I call the horse riding pain (pelvic pain but no horse riding of course) and hedge cutting pain( no hedge cutting but raising arms really hurts) . Is there a difference between an overly quick taper and a flare? Also feeling stiffness in my back which I didn't have previously. Any thoughts?

[DorsetLady PMRGCAuk volunteer]

This explains what my view - and it usually resolved by the time issues appear and/or last -

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

How were you transitioning from 10 to 9? All in one go, every day 10 to every day 9? Or using one of our slowed tapers? Over what timescale?

Have you at least slowed down for a week or so or have you carried on regardless just as you were doing at 10mg and feeling OK?

[Oshmar in reply to PMRpro]

So I was asked / told to go down to 9 mg from 10 mg all in one go and every day and it clearly hasn't worked. This was supposed to be over a 6 week timescale and I'm on the 6 th week. I did an e consult thing and am had a blood test today but know that from what has been said this is clearly a flare. Too much too soon. Why do the medics make you go at a gallop when a canter would be too much (to continue my horse riding analogy) . Its hard to take charge when they are so emphatic but obviously I need to. Thank you (as always)

[PMRpro Ambassador in reply to Oshmar]

Ignorance of the nature of the disease? Wanting to use a clearcut onesizfitsall approach which the top experts are now railing against at last. They think pred cured something - it didn't, it is a management strategy. But they only work when implemented correctly.

If this is still there after 6 weeks, it isn't steroid withdrawal. It is clear 9mg is not enough - on the other hand, 9.5mg MIGHT be but you can't be sure,

[Oshmar]

I’m definitely in a lot of discomfort so will discuss it with a firmer resolve. There’s so much more expertise here than in the GP surgery that’s for sure.

[DorsetLady PMRGCAuk volunteer in reply to Oshmar]

Yes, but they haven’t lived it -and that’s a lot different from what it says in the book - if there even is a book that is. 🤦🏻‍♀️

[PMRpro Ambassador in reply to Oshmar]

They've not walked the walk, They have been told you give pred, it is well managd with pred, taper off the pred. And they think it is much the same as using pred for an RA flare when you taper the pred once the DMARD the patient is put on is working. What they forget is that pred is our DMARD and you need to be left on enough.

[Oshmar]

I feel so thankful for the support on here.