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PMR Taper and pain

Polymyalgia Rheumatica (PMR) | Last Active: May 30 12:19pm | Replies (63)

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@dadcue

Whether it is prednisone withdrawal symptoms or PMR coming back really is hard to determine when we taper below approximately 7 mg.

I had a very difficult time at that dose too. Prednisone withdrawal symptoms are caused by adrenal insufficiency. People who attempt to decrease their prednisone dose after a long time may experience symptoms such as:
muscle pain
joint pain
fatigue
nausea
vomiting
low blood pressure

As it turns out, the adrenal glands make most of the body’s cortisol however, the body cannot immediately produce enough cortisol again to make up for the lower doses of prednisone. This results in withdrawal symptoms. or adrenal insufficiency.

The body uses cortisol for many functions:
mediating the stress response
regulating metabolism
managing inflammation
mediating the immune response
managing the levels of blood sugar reaching the brain
reducing insulin and increasing glucagon levels in the pancreas

Prednisone manages inflammation until we attempt to wean ourselves off. Taking prednisone for a long time shuts down the body's natural ability to regulate inflammation. This includes the inflammation caused by PMR. I believe the difficulty in tapering our prednisone dose below 7 mg is a combination of adrenal insufficiency and PMR.

It is necessary to wait until our adrenals begin to produce adequate amounts of cortisol again. This process can take months to happen. In most cases , it eventually happens but it doesn't always happen.

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Replies to "Whether it is prednisone withdrawal symptoms or PMR coming back really is hard to determine when..."

Thank you for all the info. I read a lot about PMR and you are well versed on this subject. So any info I receive is a blessing.

Just had a question for you. Since you have felt the symptoms coming back around 7 mgs more or less, have you been weaned on a monthly basis off the Prednisone? or Have you been weaned back over a 2 month period? I ask this question because when I was weaned from 10 mg to 7.5 mgs off the Prednisone I felt my symptoms returning (the same way I felt originally with my PMR). Then I missed one of my appointments for my monthly weaning and went back to the doctor after 7 weeks, my symptoms started to subside and I felt better (so I feel it may have been the Prednisone). Just something to think about. Not sure if this would apply to how your feeling, but thought it wouldn't hurt to let you know of my reaction with Prednisone. Thanks again for all your info!