← Return to Safe dose and tapering on Glucocorticoid therapy.

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@mtr2601

Hi, yes I am 7 months in with classic PMR and bad arthritis in both hands. Currently on 7.5mg Pred (5mg am and 2.5mg pm) plus 5mg Methotrexate. Disease is poorly controlled but I don't want to increase the Pred and the Mtx is just horrible so I'm coping as best I can, hoping things will improve.

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Replies to "Hi, yes I am 7 months in with classic PMR and bad arthritis in both hands...."

Both you and @nyxygirl are getting close to "adrenal territory." The tapering will get harder as you progress through this difficult to navigate territory. I think it is less about tapering and more about "holding your ground." The only time, I was advised to stop tapering was when I reached my 3 mg dose of prednisone when my cortisol level was low.

At or near a 3 mg dose of prednisone, your cortisol level can be checked. If your cortisol level is low ... you ain't going nowhere! Except for trying to hold your ground, there isn't much you can do until your adrenals "wake-up" ---"reboot" --- or "start to work." Your adrenals need to produce reliable amounts of cortisol again and that takes time.

Cortisol is what prednisone has replaced. Perhaps prednisone "competes" with cortisol is another way of saying it. You have to get cortisol from somewhere. If your adrenals aren't up to the task quite yet, you need to supplement your cortisol need with prednisone or some other corticosteroid.

Cortisol and/or prednisone is what "regulates" inflammation in the body. The HPA axis does a better job regulating inflammation then we can ever do with a daily dose of prednisone.

In the absence of anything else that helps to keep inflammation in check, it is difficult to taper without having a flare. In my case, Actemra made a huge difference because it keeps my inflammation in check and didn't suppress my adrenal function. I think methotrexate might help some too.

I also couldn’t tolerate methotrexate and I have been on lefluodomide 20 mg which helped suppress my symptoms and 5 mg prednisone. Good luck PMR is a bitch.