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The lowest effective dose, how is it defined?
Polymyalgia Rheumatica (PMR) | Last Active: Dec 30, 2024 | Replies (61)Comment receiving replies
Those who said the lowest effective dose was a moving target are right. My only flare so far was about 8mths ago at 6mg of prednisolone. The first pain came in at 6.5mg but was tolerable so I continued to reduce to 6mg, after which pain was 5-6/10 and inflammatory markers rose. My delay of a month or so sitting on the 6mg hoping it would get better (it got slowly worse) was the mistake which resulted in the inflammation settling in, so I had to return to 15mg briefly and start the reductions over.
This time I've made it to 6.5mg with zero pain. My doctor says to stay on 6.5mg a week or two longer than last time before slowly reducing to 6mg. Sounds good to me, fingers crossed. Pushing on after tolerable pain started has given me a higher cumulative dose of prednisone, not something I want to repeat. Slowly slowly now.
So the earlier lowest effective dose for me was 7mg. Now I can say for sure it is 6.5mg or lower. Progress.
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That 7 mg dose of prednisone was so difficult for me to get past. I’m truly amazed how many people have flares at or around 7 mg of prednisone. That dose corresponds to the physiological dose which translates to the amount of cortisol the body needs every day.
It might be time for some type of steroid sparing medication. It doesn’t need to be what I took. My endocrinologist said if I could maintain a 3mg dose of prednisone for an extended period of time that would help with the recovery of my adrenals. Sure enough… staying on 3 mg of prednisone for months did improve my cortisol level. Lo and behold … I didn’t even need to taper my prednisone dose from 3 mg to zero after my cortisol level improved.