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← Return to Prednisone to Kevzara
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I think there are many possibilities including a low cortisol level that might explain pain on lower doses of prednisone. A low cortisol level may only explain a portion of what is causing the pain.
1) Many people discover their osteoarthritis pain gets worse on lower doses of prednisone. Kevzara might not help osteoarthritis.
2) While PMR pain should be controlled with Kevzara ... PMR might be still be active to a certain degree. Symptoms rule in this regard because inflammation markers are no longer reliable because of how Kevzara works. IL-6 levels will initially skyrocket in the blood but that doesn't mean all IL-6 receptors are blocked. Some inflammation can still happen.
3) A person might not have PMR only. My case is an example. I had a long history of reactive arthritis which didn't go away after PMR was diagnosed. I wasn't having any PMR pain after I tapered to zero prednisone the first time. Actemra was clearly controlling my PMR pain. However, injections of Actemra every two weeks didn't prevent a flare of uveitis from happening even though Actemra was working well for PMR. That saga is another long story but ultimately increasing my Actemra injections to weekly was better and a monthly infusion of Actemra has worked the best.
4) It could be prednisone withdrawal symptoms as compared to adrenal insufficiency. One is more temporary while the other may be permanent. or at least take longer to resolve.
5) It could be any combination of the above things or something else entirely.
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I agree completely. You got this figured out. I think drugs like Kevzara are very useful in trying to stop any subsequent inflammation that may result from the taper. Your case in point. I even think it may be necessary for drugs like MTX or LDN to even further widen the blanket. My education in steroids comes from my wife. She has GBM. I poison her body every day by giving her DEX. But as you pointed out, its not easy to say her issues are strictly AI and cortisol. If she builds any inflammation she goes into a coma and seizures increase. She has had meningitis, hydrocephalus, sepsis, and increased risk of infections. So we are on the same page. The human body can have a million things going on that are not as easy as saying you need to reduce prednisone. My wife is a testament to that. Simply restarting her adrenals is not the answer. The same applies for most with PMR. Somehow we all picked it up. But that opens a whole Pandora's box to what might be lurking in the background.