Chronic Fatigue while tapering Prednisone for PMR

Prednisone has lingering side effects after we taper off. When I tapered off prednisone, having no energy lingered for more than a year. In my case, the low energy level was related to a low cortisol level.

Taking prednisone long term may affect your adrenal health. Tiredness and fatigue are often symptoms of adrenal insufficiency. This side effect of long term prednisone use may take months to improve. This particular side effect is why we need to taper off prednisone slowly.
https://www.verywellhealth.com/does-prednisone-tapering-minimize-withdrawal-190242
The other side of tapering off slowly is to take Prednisone for the least amount of time as possible. It is difficult to do both.

I was diagnosed with PMR in December 2023 but the symptoms began in late August. The rheumatologist prescribed 10 mg of prednisone & it started relieving the symptoms almost immediately. I saw her again in January & she suggested I begin slowly tapering off to see how low a doseage I could tolerate. I have tapered down to 4mgs (for 3 days). There is some increased pain in my hands but it is definitely tolerable. The main change I notice is increased fatigue. Wondering if anyone else has experienced this.

I was also diagnosed in December 2023, symptoms started in mid-November. When 20 mg of prednisone didn't do the trick, I was switched to methylprednisolone (48 mg), tapering down to 8 mg within 2 months. When I got down to 6 mg I had crazy stiff and painful wrists and hands - something new for me. I also had fatigue and nausea. Once I stabilize at each level for at least a week, I taper again. On April 1st I tapered to 3mg. Today I bumped back to 4 mg as I can't handle the debilitating fatigue which is getting worse by the day. I have an appointment with my endocrinologist next week to see if he can shed any light on my adrenals.

I can sympathize with you. I've been on this journey since 2020. I got down to 3 mgs. but have been flip flopping back and forth with flare-ups. Finally managed to stabilize at 3 mgs again. When I saw my rheumy two weeks ago she suggested 3 mgs one day - 2 mgs next day - then 3 mgs again continuing for two weeks, then down to 2 mgs for two weeks, etc. However, I don't have any pain but chronic fatigue and bad mood swings since I changed. I would be interested to know what your endocrinologist has to say. After so many years, I so want to get off this stuff.

I had been on prednisone for over a year and half, but gradually tapered off last spring/early summer. The fatigue hit me hard, and there were days at work where I was fighting to keep my eyes open. I have also been having major issues with my asthma. My doctor started me on hydroxychloroqine before I tapered off of the prednisone, but when I hit that 5 or 6 mg dose, it felt like it wasn't doing anything. My Rhematologist explained that I was dealing with residual pain from being on the prednisone for so long. Apparently, it takes at least 6 to 9 months and maybe longer for your body to adjust after being on Prednisone because it needs to re-learn how to produce adrenaline and other body chemicals. She tried adding Celecoxib, but it did absolutely nothing for me, so we stopped. Then we slowed my taper a bit and she added Diflunisal and Tylenol Arthritis to the mix. This helped a lot and I have now gotten to the point that I no longer need the Tylenol. I also stopped taking my nightly dose of Diflunisal, though I still feel it a bit in the morning until I take my morning dose. I should also note that I am an MGUS patient (the earliest stage of multiple myeloma) and during my bloodwork, it was discovered that my ferritin (stored iron) was low, even though the iron in my blood was normal. I now receive ferritin infusions which has helped not only my fatigue and anemia, but also slightly relieved my pain and helped with my breathing. I don't know if any of this information can help anyone, but I hope it will. God bless.