problems with starting dose of prednisone.

[Gatorchief]

My primary care Dr diagnosed the PMR and prescribed 15mg prednisone a day for 30 days. Having read up about high ESR’s and CRP levels that standard prescriptions were 40-60 mg a day with tapering 5mg a week to reach a near maintenance dose to tapper from slowly. The 15mg didn’t have much effect on the pain so I added 10mg to the daily dose and it was night and day for the relief. So I tried to reduce 5mg to make it a 20 mg dose. The only problem was at about 4:00 am my wrists and hands started to ache. It got progressively worse until it was time for the prednisone. At 25 mg it was great . At 20 mg after 18 hrs I could hardly use my hands again and the pain in the thighs, hips, and groin started to come back. The prednisone started to alleviate the pain again in about an hour . The next day was about the same experience with the pain at 4:00 am. So this morning at 4:00 I took a 7.5 mg Meloxicam and the pain in my hands and wrists was about 60% better and tolerable until the time to take the prednisone. I’m attempting to try and apply the 15 mg dose prescribed by my primary care Dr with the addition of the 7.5 mg Meloxicam ( prescribed by my orthopedic Dr) to avoid trying to convince her I need the 20mg a day at least for now. Good plan, bad plan . Thoughts?

[PMRpro Ambassador]

I have no idea where you got that information from - but those are doses for suspected GCA. There is no real relationship between the inflammatory markers and the starting dose required.

However, if you need 25mg to get good relief, that is what you need. You won;t stay there forever - but you DO need to stay there for about 3 weeks to clear out accumulated inflammation before starting to taper.

The 4am pain is natural - the inflammatory substances that cause the problem are shed in the body at 4-4.30am and start to creat fresh inflammation until the next dose of pred takes effect, The ideal time to take prednisone for maximal relief of the morning symptoms is 2am. You may find that that has a better result - although if the antiinflammatory effect of pred doesn't last the full 24 hours for you, an even better result cames by splitting the dose, taking about 2/3 in the morning and the rest a few hours later often does a good job without needing to wake in the middle of the night.

I do have to say though, that if meloxicam is relieving a lot of the pain, it potentially suggests it possibly isn't just PMR, it may not even be PMR, since none of the NSAIDs usually have any effect on PMR - just pred.

[DorsetLady PMRGCAuk volunteer]

40-60mg is for GCA, not PMR….and 25mg is usually the top dose for PMR,

You haven’t been on the initial dose long enough to know if it’s effective [and your comment in bio about relief within 1-3 days is wishful thinking for many].

You may require 20mg….but really you shouldn’t be juggling your dose. It’s all part of diagnosing the disease, so you should be reporting your issues to your doctor and agreeing together whether to increase your dose, and at what level.

But you need to give the Pred time to work.

Suggest you read the info I sent in first post…

[piglette]

Why did your orthopaedic doctor prescribe Meloxicam? I assume it was nothing to do with the PMR diagnosis?

[Gatorchief in reply to piglette]

I had a torn left knee meniscus that my orthopedic dr scoped and clean up , and prescribed Meloxicam for pain. This all happened about the same time the PMR symptoms started to really affect my everyday routines.

[piglette in reply to Gatorchief]

Ah I understand.