Small Dose Prednisone Therapy

I'm definitely not an expert but just a patient like you but with the average starting dose of 12 to 25 mg prednisone for PMR I don't see how 1 or 1.5 mg would even help. If I'm not mistaken one of the hallmarks of PMR is that the pain goes away shortly after taken your first dose and stays away pretty much until the next day. At least that's how it was for me on both occurrences I've had of PMR. I was started at 20 mg for both and within a couple of hours of taking the first dose for both times the pain was gone until the next morning. That's not to say that a low dose wouldn't help the symptoms if it's not PMR.

Treatment of polymyalgia rheumatica: https://www.uptodate.com/contents/treatment-of-polymyalgia-rheumatica/print

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.

Hi John and thanks for responding. I'd like to read the article but don't have a sign in and need to go out and run some errands. I will try to sign up when I return. From what I could gather from a few paragraphs, there is not set dosage for pred for pmr, but I'm sure I read that wrong. There are probably plenty of articles on how a baseline dosage was created. I'm wondering though, if I asked, if docs would at least try this on me, since I have every side effect on the list already. I do wonder if the inflammation from PMR increases without medicinal intervention. That is one thing that I do find concerning. My doc seems to think that keeping me med free for over a month is fine. I have an ultrasound scheduled for 4/30 and last time I saw her was early in March, so....
I just wonder.
I'm thinking of asking for labs next week just to see where I am. I don't want inflammation to get to dangerous levels.
Anyway, thanks again for your info and help.

@glinda, Sorry about the having to create an account to read the previous one. Here's another paper that you can see without having to create an account.

--- Evidence on treat to target strategies in polymyalgia rheumatica and giant cell arteritis: a systematic literature review: https://academic.oup.com/rheumatology/article/63/2/285/7261503

Thanks John! No problem on creating an account. I just didn't have time as I had to go out.
Appreciate the link.

Thanks Emo. I want to avoid steroids at all costs due to already having all the side effects associated with it.
There has been little research on PMR ergo pred remains the go to and works well for most people who can tolerate it. I'm also turned off by the fact that docs don't do enough digging and looking for possible infections or other reasons for this condition and just throw pred at it. I would also have to take osteo infusions and that's another group of drugs I can't tolerate.
Tell me, now does PMR put one in danger? Thank you.

You should keep an eye on your blood tests. Ask the Dr for copies and where to look for ESR and CRP results and what is normal. You may have a relatively low level of inflammation and the Dr doesnt want to slam you with high dose Pred and set you up for unnecessary problems trying to get off it.
There are a number of conditions that can mimic PMR and may not require Prednisone and if your inflammation levels are increasing, there are a lot of things you can do to help control it. Lots of research needed !!! Good luck.

My Rheumy was quite clear in stating that PMR is very debilitating but doesnt do any actual damage to joints and muscles. The damage is done by avoiding movement due to the pain experience. Prednisone takes away the pain by dampening the inflammation but causes a lot of damage and often doesnt 'reboot' the immune system in a sustainable manner.

Can you explain what "reboot" the immune system means? I suspect it has something to do with adrenals being able to produce cortisol. Cortisol is the hormone that is supposed to regulate inflammation instead of prednisone.

"Suppressing inflammation: In short spurts, cortisol can boost your immunity by limiting inflammation. However, if you have consistently high levels of cortisol, your body can get used to having too much cortisol in your blood, which can lead to inflammation and a weakened immune system."
https://my.clevelandclinic.org/health/articles/22187-cortisol

Im not a Doctor but have a basic understanding of biology. As i understand it, PMR is caused by the immune system going into overdrive and attacking proteins that it shouldn't be reacting to. This leads to a pain sensitization feedback loop. Prednisone blocks the inflammatory response while you are taking it and blocks the pain sensitization loop. In a small percentage of PMR cases this reboots the immune system and can send the disease into remission but for most people Prednisone is just a bandaid and underlying causes of inflammation (which havent been clearly identified by science yet) continue to cause problems. Is this your understanding?