I’m in the same boat as @johnbishop; a patient and not a medical professional, but I don’t see how that would work. PMR is one of the seemingly few inflammatory autoimmune conditions with an established evidence-based and straightforward treatment protocol (whereas many other conditions require trial aid error of various potential medications that may or may not work) and with the average starting dose established at around 15 mg…I just don’t see how it would work to start with a microdose.

I understand the idea of wanting to titrate upward—I’m severely sensitive to medication, so I often have to do things that way—but it ultimately takes a higher dose of prednisone to quash the inflammation of PMR and with it the most debilitating symptoms, I would think it would take much longer to be effective. I suppose it would eventually work, but might put someone in pain or possible danger for longer than needed, and it might not be as effective as starting at a larger dose.

Are you having severe reactions to prednisone? We haven’t run into this, but it was my understanding that for those who absolutely couldn’t tolerate prednisone (i.e. allergic reactions or severe side effects) or were non-responders, methotrexate or one of the new biologics could be tried. My father’s rheumatologist mentioned methotrexate, but ultimately he didn’t need to switch. The impression I got was that would only be done if absolutely necessary though.