I'm guessing the definition of a flare up for PMR is different for all of us depending on how we rate the level of aches and pains along with what level is unacceptable or difficult to live with. 🙃 For me that's been anything on my scale of 1 to 2 or less, mostly because I also have degenerative disc disease, arthritis, osteopenia and a few others that remind me every once in awhile that they are still there.

I wasn't sure what a flare was till I had one. My usual slight aches after each reduction had always resolved within a week or so, followed by a couple of weeks of being ache and pain free till the next reduction. A small early evening dose (split dose) meant I had zero pain at any time, including mornings.

Then one time the aches didn't resolve before the next reduction was due and I knew something was different, but the aches were minor, so I reduced another .5mg. Then the aches became minor pain, not just stiffness and aches, and over a few weeks the pain went from 1-2/10 to 5-6/10, and I rang the doctor to say I was having a flare. It couldn't be left any longer by then - doorknobs were hard to open, I couldn't lift things any more, and it was getting worse. Blood tests confirmed that inflammation had risen again. That's a flare.

Good question ... what a flare is to one person isn't a flare to another person. This stems from the misconception that we should be "pain free." Nobody ever promised me that my life would be pain free just because I took Prednisone. It isn't helpful when people increase their Prednisone dose for "niggles" of pain when another intervention would be better.

Another problem is when something hurts for "no apparent reason." People like to call it a PMR flare or somehow related to PMR. Prednisone is very effective at relieving all kinds of pain and not just PMR pain. When the pain is relieved with Prednisone, it reinforces the idea that it must be a "PMR flare" or somehow caused by PMR. I did this even though the pain was not at all similar to the pain I felt when PMR was diagnosed.

I would increase my Prednisone dose and say it was PMR related. I did this even when I was presented with evidence to the contrary. I had osteoarthritis everywhere they looked and I still think it is autoimmune related. I miss prednisone because it made my osteoarthritis feel better than it does now. I won't take prednisone again because I now accept the fact that I have osteoarthritis.