Prednisone myalgia is more about how muscles shrink or atrophy when someone is on Prednisone. The muscles will eventually break down on prednisone. I don't think it is known what causes this but it is a well documented side effect of long term Prednisone use. Elderly people have muscle atrophy due to aging. It becomes hard to separate out how much of the muscle atrophy is caused by Prednisone and how much is caused by aging.

The muscles in my legs wasted away more than the muscles in my arms. My legs are weaker than my arms but much of my leg weakness is caused by spinal stenosis. It is similar to someone who has a spinal cord injury and they lose innervation to their muscles. No innervation to the muscles will cause muscles to waste away from not being used. This is something else that causes muscle to atrophy.

PMR is somewhat of a perfect storm for muscle disease. We are elderly to begin with so we are already losing muscle tone. Then PMR makes it painful to move so we stop exercising. If we try to exercise we pay a price from doing so. We are told to "take it easy" and "pace ourselves." However, PMR has been shown to not cause significant muscle or joint damage so I think people should be encouraged to keep exercising. I discovered water exercise was ideal for me after I got off Prednisone.

I didn't attempt to do that much exercise when PMR was active. I felt like I wasn't able to do that much. That was probably true on land but not in the water. Walk-in pools are wonderful although I can now use the steps to get out of a swimming pool. I honestly thought I couldn't swim anymore when PMR was active. I was overjoyed when I found out I could still swim. You don't even have to swim. Walking in the water and moving around without the fear of falling is a great form of exercise.

I have not heard of "Prednisone fatigue." In my early days with PMR, I sometimes took additional Prednisone so I could exercise. Not only did Prednisone relieve the pain during exercise, it wasn't so painful after exercise. I felt like Prednisone gave me extra energy.

"Adrenal fatigue" refers to the adrenal glands getting "tired" because people are overly stressed. In theory, the adrenals are "overworked" and can't keep up with the body's need for more and more cortisol. The medical community doesn't believe that happens in reality. However there is no doubt that Prednisone suppresses the adrenals glands and "turns off" the production of cortisol.

Adrenal insufficiency as compared to "adrenal fatigue" is characterized by overwhelming fatigue. I think this is why people with PMR who take prednisone for a long time complain of being tired all the time. The chronic inflammation of PMR also causes fatigue but I don't think that was what caused the majority of my extreme fatigue. I was "tired" in the early stages of PMR but Prednisone energized me. It wasn't until I was on Prednisone for a couple of years when the "overwhelming fatigue" set in.

I got into trouble for saying this on another forum but I truly believe it. Prednisone is great for PMR in the short term. I don't know how long is too long but certainly taking it for 12 years like I did was too long. I believe PMR in the early stages is treatable with Prednisone as long as PMR is "self limiting." However, the longer PMR lasts ... things get worse when you toss in some of the well known side effects from Prednisone.

When you consider how Prednisone myalgia is a side effect and causes muscle pain and inflammation. When adrenal insufficiency sets in it causes overwhelming fatigue and more pain. We become dependent on Prednisone as a form of synthetic cortisol to relieve all the pain and fatigue. I think it is more of a miracle that anyone is able to taper off Prednisone. The real experts in my opinion are people who can taper off Prednisone in a reasonable amount of time.

My rheumatologist still thinks I have PMR treated with Actemra instead of Prednisone. I feel so much better being off Prednisone. I have to wonder if Prednisone was causing many of the problems that I used to attribute to PMR.