You are a miracle child. You need to donate to science. Ok. I agree. I had a lengthy discussion on another site concerning how this all got started and how the body uses both natural cortisol and prednisone cortisol once you reach the 3mg range. I like you dont know the answer any better today. But lets take another example . My wife who has GBM. She was on 4mg dexamethasone. They told me to taper off so she could start immunotherapy. I could get her to 2mg and her inflammation would increase and she would get hydrocephalus and go into almost a coma like state. No pain with it. just go into a coma. Not at all the same symptoms as PMR. But Cortisol still had its role in her reaction to the taper. My education in corticosteroids is from a failed attempt to help my wife. Cortisol and PMR symptoms as you described are intertwined. Their relationship is dependent on each other. Where I get frustrated is the term PMR flare. Seems to be over used. Although it definitely describes the condition you are in.