Symptoms disappear completely after Prednisone dose.

[Wonabit15]

I’m a 76 yo very active runner, hiker and biker. Diagnosed about 3 months ago. Lab work did not confirm my diagnosis but my early morning symptoms fit the criteria. Started on 15 mg approximately 10 weeks ago-currently on 10 mg. No Giant Cell symptoms.

My response to prednisone was amazing after one morning dose. I take prednisone every morning at 6am. Since the first dose (in February) my PMR symptoms completely disappear after about 3 hrs. I virtually am pain free from 10 am but symptoms are awaiting when I get out of bed the next morning.

BTW I have some issues with wt loss

The only symptoms that persist from 10 am on seem to be Prednisone side effects?

These include intermittent:

Brain fog, anxiety, depression.

Is it normal that my PMR symptoms almost completely disappear after about 3-4 hours? This has been the case since day one.

John

[DorsetLady PMRGCAuk volunteer]

Hi and welcome

Yep - sounds about correct. But just be aware your PMR isn’t gone it’s just well controlled -at the moment - which may or may not change as you reduce the meds. And the side effects you mention are typical.. apart from weight loss which may be a bit more unusual.

.. and this link includes info on why they return each morning -as well as a lot more -

healthunlocked.com/pmrgcauk...

[Bunchberry]

Hi John, Disappearance of symptoms after just a few hours was my response to first starting prednisone, and continued until I tapered to 10.5 (I’m now at 9.5). Since then, I experience some ongoing soreness during the day, but at a level that doesn’t interfere with my life. And I definitely experienced brain fog the first couple of months, but it then stopped. I don’t remember any anxiety or depression in response to the prednisone.

[piglette]

Sounds like things are going well. Pred is a wonder drug.

[SnazzyD]

I won’t repeat what others have said but with the weight loss, it may be the Pred side effect of causing muscle loss. This can make the numbers go down. It’s normal to particularly lose it in the arms and legs and what fat you have repositions around your middle, neck and face. So you can end up with clothes not fitting as if you have put weight on and yet your arms are on the thin side. So, keep an eye on the nature of your weight loss to see if it is numbers, belt size, or in any other dimension. Generally, people gain weight and have to seriously cut carbs. Some here have reported weight loss though it can be a temporary run on of the normal weight loss from untreated autoimmune activity.

[PMRpro Ambassador]

Hi and welcome,

That is exactly what you hope for - that you are on enough pred to manage the daily new dose of inflammatory substances that cause the symptoms. Almost all of my symptoms went within about 6 hours of my first dose of 15mg pred. But the pred has cured nothing, it is a management strategy, and you are now on a downward path looking for the lowest effective dose, not heading relentlessly to zero. The fact you have symptoms in the morning is possibly that the antiinflammatory effect of your pred isn't lasting a full 24 hours so it isn't working immediately the inflammatory substances are shed in the body at 4-4.30am so some inflammation gets hold. Was it any better at the starting dose?

Your adverse effects MAY be the pred, but could equally be the PMR as it too can have those effects - or it may be a bit of both.

[Tappo]

I lost nearly a stone in a fortnight when first diagnosed, which triggered a whole heap of investigations for ‘nasties’. Nothing abnormal detected and I soon put all the weight back on once the Prednisolone got into my system 🙄😆. Always best to get it checked though 🥰

[PMRnewbie2017]

One of the reasons we advocate taking Pred at 2am ish is so it is there to mop up the cytokine release at 4am. That way, if your dose counter balances the amount of inflammation, you should waken pain free. As you are new to all of this, perhaps give it a try.

[Smithie49]

Hi. I'm sorry you've had to join the group but it has been a wonderful source of info for me over the past 3 1/2 years since I first started down the PMR road! I followed advice as PMRpro and others have written and take 5mg pred as near to 3.00am as I can (dependant on waking for a rip to the loo!). I can then get up at my normal time pain free and take the remainder of my dose with breakfast. I had brain fog before I started pred had an odd headache behind my occipital lobes, my neck was stiff and my legs felt rubbery. A few hours after my first dose of pred I felt normal again. It was a memorable moment. I hope your PMR doesn't linger too long.

[ChrisBeeLoop]

When you say “lab work did not confirm my diagnosis” do you mean that your CRP test was normal? I believe that is the case in about a quarter of patients. As the others have said, it sounds as though you are responding normally to your treatment: a bit of brain fog, bad tempered grouchiness, and morning aches and pains are all par for the course. My morning aches usually ease about 90 minutes after taking Pred. If you have coated tablets it will take longer. Anxiety and depression are recognised side effects of steroids. They are usually short term so you will get through them.

A word of warning, you say you were a very fit runner, hiker, biker. Sorry, but those days are now on hold, for quite some time. With your exercise routine, particularly biking, you were probably pushing your muscles to the limit with a regular cycle (sorry, pattern) of stress, inflammation, recovery. That inflammation which was part of your fitness routine has now got out of hand and turned into PMR. You should not expect to get back into that fitness regime until your body is back in balance and all that inflammation is well and truly out of your system. This is NOT a short term illness which you can slough off in a week or two; this is a long term, slow road to recovery.

Apologies for the negativity but it is important that you take time to understand your condition, read through the stories coming up on the forum to see what problems you might encounter, and understand that life has changed and you now have an Auto Immune Illness. Take note of that word AUTO. It is YOUR body telling you it has had enough. Listen to it, treat it gently, take it slowly. Also, instead of thinking about what you can’t do, read the other stories and feel grateful for the things you still can do, that others on here can't.

Apologies again, that was quite a sermon.