Nighttime Prednisone Could Address Morning Stiffness

[Markandevie]

For the past 18 months, I have taken my steroids at 2.45am and drastically reduced the pain felt in the morning. I have added a link to a case study that some may find helpful. What do you think as I 100% agree that it is positive for sufferers of PMR and other inflammatory diseases.

hcplive.com/view/nighttime-...

[DorsetLady PMRGCAuk volunteer]

I think you may be preaching to the converted. Linked article is from 2016.. and this information has been in my intro for at least 6 years -but always good to be reminded -although we do that on a regular basis 😉😊

Recommended time to take most Pred is early morning, with or after food. However, as the cytokines that trigger the inflammation are produced daily around 4am; some people find that by taking the plain uncoated tablets around 2am or the coated ones or slow-release ones the evening before it is fully in their system by that time, and it is ready to fight the inflammation.

[Markandevie in reply to DorsetLady]

Agreed it's old news but can be a dramatic improvement and always worth sharing

[Kritterkid in reply to DorsetLady]

Morning! If I take it at 2:45am, do I have to sit up for a while to let the pred reach a certain part of my digestion system or can I lay down immediately and go back to sleep? Thank you

[Markandevie in reply to Kritterkid]

I take it with a small yogurt drink and straight back to sleep. Never had any issues. Good luck

[DorsetLady PMRGCAuk volunteer in reply to Kritterkid]

Most people can go straight back to sleep... provided it taken with something to help it on its way, and add protection for digestive system..

[PMRpro Ambassador]

We have been recommending that approach and discussing it for the last 8 years and before that we said as early in the morning after 4am as possible. I personally have been on the form of prednisone, Lodotra, which was developed to make the approach easier, for that long. It is taken at 10pm within 3 hours of your evening meal or with a substantial snack, it releases at 2am and is processed in the liver to be available as prednisolone by 4am.

Probably the first study to look at the idea in RA was back in 1984 by de Silva

sciencedirect.com/science/a...

but another was started in about 2008 - though I imagine the patients were selected retrospectively.

pmc.ncbi.nlm.nih.gov/articl...

[powerwalk in reply to PMRpro]

If you take the coated Pred the evening before, would it mess up trying to get the adrenals to kick in? Ive been tempted to do it as my mornings are quite awful. Though i dont think my adrenals will ever come back i think ive just gone too far at this stage. (I was told the wont be back!!) But in my head i live in hope!

[PMRpro Ambassador in reply to powerwalk]

Enteric coated you mean? Depends how late you take it really - it takes 3 or 4 hours at least to get into the system so taking it after 10pm should mean that it hasn't got there about midnght, With the lack of availability of Lodotra in the UK, Prof Mackie and I did discuss it and we reckoned it would be possible with e/c. She told me they had asked about doing a head to head trial between Lodotra and e/c pred and the Lodotra company got all iffy. Which suggests to us, they know it would work!! You don't get the enteric coated outside the UK so they are safe at present!

[powerwalk in reply to PMRpro]

Im tempted to try, then i chicken out. Probably lookin for a miracle! Though my pharmacy gave me the wrong pills the other day, only i noticed they were the wrong colour when i went to leave them out. Could've had a good month if id not noticed and been on 10mg a day instead of 5mg for the month!

[PMRpro Ambassador in reply to powerwalk]

I'd try it - you have nothing to lose, If you are on e/c and not taking it until the morning, no wonder your mornings are rubbish. Or you maybe need to split the dose to extend the duration of the antiinflammatory effect until the next dose is due.

[Excelsior80]

I find it fascinating that things happen at fairly specific times. I had no idea.... Like, level of steroid at midnight is important, and cytokines released around 4am. Amazing!

[PMRpro Ambassador in reply to Excelsior80]

Circadian rhythms - your whole physiology is based on them!! Bit like the planets and their orbits ...

[Markandevie in reply to Excelsior80]

Hope it helps

[Maisie1958]

I feel absolutely fine atm (on 7.5mg MTX and no Pred) but used to wake up hot and decidedly bothered at 3.50am every day when inflammation not controlled. I tried to find anything else that would wake me up then eg milk man, heating coming on unnecessarily etc but it seemed it had to be those cytokines… It was incredible how consistent it was - I wouldn’t have believed it.

[Markandevie]

I remember looking back on my PMR journey that if I woke up at 1am for example, I could get out of bed, go downstairs and use the loo, all pain free and with joints working....... wake up 4am and could not move and in incredible pain. Since I moved to 2.45 am over 18 months ago the difference has been incredible