Prednisone reduces inflammation levels whenever we take it. However, prednisone doesn't stay in the body very long so people need a daily dose. You may or may not have enough prednisone for an entire 24 hours. If a person's prednisone dose is too small then inflammation isn't reduced enough. Too much prednisone isn't good either

When the adrenals and HPA axis are working correctly, a person's cortisol level is regulated. Cortisol levels are regulated so the body gets what it needs - it gets cortisol whenever it needs it -- in real time -- almost instantly. Having too much cortisol and/or not enough cortisol is all prevented when the HPA axis is functioning well.

The HPA axis can get out of balance and needs to be reset somehow. I don't think prednisone is the answer because it throws a wrench into the works and shuts down the HPA axis.

Basically, I think Actemra reset my HPA axis by contolling my inflammation without suppressing my adrenals. Does this explain how I got past adrenal insufficiency?

Unfortunately, Actemra won't address the problem with "immune system memory." My rheumatologist says my immune system isn't likely to forget about what it has been attacking for so many years. That is why I need to continue taking Actemra because my immune system will continue to attack me. Actemra seems to be blocking the excess inflammation caused by PMR but when I stop Actemra, the inflammation returns. However, I feel much better because my adrenals aren't being suppressed by Prednisone any longer.

Now I can exercise and handle stress better because my body is getting the cortisol it needs. I'm not having the inflammatory flares anymore when my need for cortisol needs to increase. I guess that explains why cortisol is the "stress hormone."

Prednisone only works for the length of time it stays in the body before it is eliminated.

A monthly infusion of Actemra works for an entire month or until the IL-6 receptors aren't blocked sufficiently. I guess that is when the pro-inflammation effects higher levels of IL-6 start to return and the pain increases again.

Whatever the explanation. I am just grateful Actemra seems to work! The conflict about how much Prednisone I should take is not an issue for me anymore.