Prednisone cumulative dose in PMR

Posted by maye @maye, 1 day ago

I’m wondering what cumulative dose of prednisone have my fellow PMR / GCA forum counterparts received from commencement of prednisone treatment to remission?

What would be an average cumulative dose?

And what would be considered a very high cumulative dose ?

Those who have received a high cumulative dose , what are your long term effects ( if any ) ??

And if minimal / or no effects what did you do to prevent /or treat long term effects?

I have GCA/PMR diagnosis since Nov 2024 and am forward planning to be as well as I can be ( just like all of us !) and would appreciate hearing about the lived experiences of the people in this forum .

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

What is most important are cumulative long term effects and being proactive
in anticipating ways to avoid the common problems. Mediterranean dietary
habits and exercise will help forestall metabolic problems and weight gain.
Learn to monitor your glucose at home monthly and have A1c testing twice
yearly. A baseline bone density is helpful in addition to vitamin D and calcium.
Have your home blood pressure cuff handy to check every 2 weeks.
Sleep and stress management are very important. Consider a cardiac risk
assessment for your systemic inflammation. Update your vaccination schedules and know your lab numbers. It is a good idea that you will know
your cumulative steroid dose and it can help you understand how to wean
off meds when it is time.

REPLY
@dadcue

It would be safe to say that my cumulative dose over my 13 years of PMR treatment with daily Prednisone was "massive." That doesn't count the prior 20 years of intermittent high doses of Prednisone to treat other autoimmune conditions.

I didn't have too many side effects during my 20 years of short term Prednisone use prior to PMR. I usually took 60-100 mg and tapered off again in a month or two. I had early onset and rapid cataract formation at the age 40 which was devastating to me at the time.

After PMR was diagnosed, my daily long term Prednisone use was approximately 30-40 mg for the first 5 years and 20-30 mg for the next 5 years.

A remarkable thing happened to me after 10 years of PMR. A person who experienced an adrenal crisis took me under her wing and explained a few things to me. She explained that many of my symptoms could be attributed to adrenal insufficiency caused by long term Prednisone use. She said it was imperative that I preserve whatever adrenal function I had left.

An amazing chain of events happened during my 10th to 12th years of PMR. I was able to have surgery on some "problem areas" and the corrective surgeries enabled me to taper down to 10 mg. Treatment with a biologic followed and I tapered down to 3 mg of Prednisone. I had to stay on 3 mg for six months in order to give my adrenals some time to recover. After my cortisol level improved and was deemed to be adequate as determined by an endocrinologist, I discontinued Prednisone.

I don't know how many side effects were caused by Prednisone. I just know my 13 years of daily Prednisone use were tumultuous and characterized by emergencies and hospitalizations.

While taking Prednisone daily, my medication list expanded to more than 10 other prescription medications. All of these medications were treating or preventing Prednisone side effects.

Currently I do a monthly infusion of the biologic and much lower doses of only two of my remaining prescription medications. The weight I gained while on Prednisone has been stubbornly resistant. I'm working on that side effect and I'm slowly making progress. At least I'm able to exercise again without having a flare and experiencing overwhelming fatigue.

I have been off Prednisone for 4 years. My overall health and quality of life have steadily improved since Prednisone was discontinued. I still have a prescription for Prednisone "as needed" but I never use it.

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DadCue, what a tumultuous health history you have!
Glad to hear side effects improved with the cessation of prednisone despite your “massive “ cumulative doses.
Hopefully you continue in better health from here on in.

REPLY
@jeff97

An interesting question occurred to me based on this post. I wonder how many people who have achieved remission actually stick around afterwards and keep posting on the forum. One of the biggest motivations for me to follow the forum is to learn about the diseases (PMR and GCA) and their treatments. I want to know what to expect, what the typical problems are, etc. Other motivations are to help other people and to feel less alone, since going through PMR and or GCA can be an isolating experience. So the motivation to be on the forum after remission would be a little different than before.

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All good points Jeff97
I’m thinking since PMR / GCA are chronic remitting diseases forum participants likely continue to check in , and or contribute , to this forum even if in remission.
As you say an ongoing motivation to help others with their experiences/ knowledge is a consideration too.

REPLY
@dadcue

It would be safe to say that my cumulative dose over my 13 years of PMR treatment with daily Prednisone was "massive." That doesn't count the prior 20 years of intermittent high doses of Prednisone to treat other autoimmune conditions.

I didn't have too many side effects during my 20 years of short term Prednisone use prior to PMR. I usually took 60-100 mg and tapered off again in a month or two. I had early onset and rapid cataract formation at the age 40 which was devastating to me at the time.

After PMR was diagnosed, my daily long term Prednisone use was approximately 30-40 mg for the first 5 years and 20-30 mg for the next 5 years.

A remarkable thing happened to me after 10 years of PMR. A person who experienced an adrenal crisis took me under her wing and explained a few things to me. She explained that many of my symptoms could be attributed to adrenal insufficiency caused by long term Prednisone use. She said it was imperative that I preserve whatever adrenal function I had left.

An amazing chain of events happened during my 10th to 12th years of PMR. I was able to have surgery on some "problem areas" and the corrective surgeries enabled me to taper down to 10 mg. Treatment with a biologic followed and I tapered down to 3 mg of Prednisone. I had to stay on 3 mg for six months in order to give my adrenals some time to recover. After my cortisol level improved and was deemed to be adequate as determined by an endocrinologist, I discontinued Prednisone.

I don't know how many side effects were caused by Prednisone. I just know my 13 years of daily Prednisone use were tumultuous and characterized by emergencies and hospitalizations.

While taking Prednisone daily, my medication list expanded to more than 10 other prescription medications. All of these medications were treating or preventing Prednisone side effects.

Currently I do a monthly infusion of the biologic and much lower doses of only two of my remaining prescription medications. The weight I gained while on Prednisone has been stubbornly resistant. I'm working on that side effect and I'm slowly making progress. At least I'm able to exercise again without having a flare and experiencing overwhelming fatigue.

I have been off Prednisone for 4 years. My overall health and quality of life have steadily improved since Prednisone was discontinued. I still have a prescription for Prednisone "as needed" but I never use it.

Jump to this post

Wonderful for you. Prednisone is such a help when needed but adds other problems after continued use.
Hoping to get off before the weight gain is a problem. Going from an active healthy person to daily pain is daunting.

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