Flare or adrenal?

[Jigsawlass]

I'm currently on 1.5mg , reducing by 0.25mg every 4-6 weeks , on the suggestion by my rheumy, who I think is v good . The last reduction from 1.75 to 1.50 was fine , no issues. This reduction was fine up until recently. Pred not completely knocking mild shoulder and arm pain on the head, some pain in the base of my spine, a feeling of heavy legs and some "dizzy " days due to fatigue . Do I add in another 5mg for a week to see what happens or is it adrenals having to work harder due to the low dose ? Diary pretty much cleared for the week to allow for lots of rest ! It's midday and I'm still in my pj's!

[DorsetLady PMRGCAuk volunteer]

Would say maybe a combination of both. Pain sounds like too little Pred-dizziness and fatigue definitely adrenals.

You might find a week or two at 5mg helps the pain -and then drop to 1.5mg and remain there for a month or so to let the adrenals catch up…

[Jigsawlass in reply to DorsetLady]

Thanks , I'll do that . Would you suggest I go up to 1.75 after the extra 5mg or back to 1.5 ?

[DorsetLady PMRGCAuk volunteer in reply to Jigsawlass]

Probably a more sensible idea to go for 1.75mg, even though you said taper from there to 1.5mg was okay before, best not to take for granted it will this time.

[piglette]

You seem all set up to improve things. When you go down again, do it in two steps. Best of luck.

[PMRpro Ambassador]

I think that if it continues to get worse you have to consider it is flaring inflammation - if it had started immediately after the change in dose, then I'd have thought steroid withdrawal and adrenals a bit behind but from what you say it took time to appear? And to me, that almost always singles out one from the other.

[Jigsawlass in reply to PMRpro]

Thanks , I always assume that steroid withdrawal takes a few weeks to settle ,so was surprised when this kicked off over 4 weeks into the reduction. I'm going to add in the extra 5mg and treat as a flare . Not great timing as things get busy for Christmas but has to be done !

[DorsetLady PMRGCAuk volunteer in reply to Jigsawlass]

No steroid withdrawal is usually immediate , and only lasts a few days to a week, it a flare that takes longer to materialise - this explains -

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador in reply to Jigsawlass]

Steroid withdrawal is your body protesting about some aspect of the change in dose - so happens as soon as it is different. A flare usually takes some time to build up enough inflammation to be noticeable although if you are already on the cusp and reducing in bigger steps than we like, you might feel it quickly too. But it gets worse over time whereas as your body adjusts to the new dose, that should improve.