flare or bad patch?

[Jakey67]

how do I tell if I am having a flare or just a bad patch?

diagnosis in May, tapered down to 10 mg. Had one flare in September probably triggered by holiday issues. I have had a batch of stress recently which has now abated. I have more pain, stiffness and I’m back to coming down stairs one at a time so mobility reduced. I really don’t what to up the prednisolone ( presumably back to 15) unless I really have to because it feels like a backward step desperately trying to make progress. I have felt like this, to a greater or lesser degree since Monday. Any advice please how to tell if it might right itself or it’s a flare and needs the extra meds. Thanks.

[DorsetLady PMRGCAuk volunteer]

This contains advice for flare - and you only go up temporarily- with no need for a slow taper back down once you have things under control.

healthunlocked.com/pmrgcauk...

And maybe ease up on tapering for a while - it’s not a race. Rushing too quickly will just make life more difficult in the long run.

[Jakey67 in reply to DorsetLady]

Thank you.

[piglette]

Remember increasing the pred is for just a week or so to hit the PMR on the head and then you can reduce again, so it is not going back to the beginning for any length of time.

[PMRpro Ambassador]

How do you see the difference between "a flare" and "a bad patch" - because I suspect what you are talking about is the same thing. And how do you see "desperately trying to make progress"?

There is no cure for PMR - by that, we mean that no drug or other procedure like an operation stops the disease and it goes away. PMR is a chronic disease that lasts an indeterminate length of time, anything from a year or two to 10 years or even longer. A few of us have it for life. All that can be done in the meantime is manage the symptoms which are caused by accumulated inflammation in various body tissues such as muscles, ligaments and tendons and joint linings. The inflammation is due to a misfunction of the immune system in which it is unable to recognise body as self so it turns on body tissues and attacks them as if they were foreign bodies that shouldn't be there. Inflammation causes pain.

You start with a dose that should be more than you need and then you taper it slowly to find the lowest effective dose - the lowest dose that provides the same degree of symptom relief that you got with the starting dose - which is why it is important you start with enough pred and clear out the inflammation before starting to taper. You identify it by tapering the dose slowly until one dose was fine, but with the next you start to feel symptoms again. You then go back to the previous dose, the dose at which you were OK.

You appear to have reached that dose for now - you are at the next dose, the one that is not quite enough and you need to go back one step. That is not "not making progress", that is achieving your aim. Staying at a dose that is too little and allows inflammation to build up again is "not making progress", you will deteriorate again and if left, you will need to go backwards to get things under control.

You can't force the process, PMR will always win. It doesn;t mean you won't get lower - just not yet.

[Jakey67 in reply to PMRpro]

Thank you for your response.