If you have tapering problems below 5 mg this might explain why.

Cortisol is what the adrenals produce. The glucocorticoid that is nearly identical to cortisol is hydrocortisone; Cortisol and hydrocortisone are essentially the same molecule --- when referring to cortisol as a medication, it is called hydrocortisone. That was why my endocrinologist would have preferred that I switch from prednisone to hydrocortisone when my cortisol level was low.

Prednisone and other glucocorticoids are not the same as cortisol. They all have different properties and different molecular structures. They are all similar to cortisol though. When we take prednisone the body thinks there is cortisol in abundance so the adrenals stop producing cortisol.

Over time, the adrenals "forget" what their function is because there is more than enough prednisone present. When we taper our prednisone dose lower, that is when there isn't enough prednisone and no cortisol. The adrenals don't immediately produce cortisol again and only in spurts. The adrenals have to resume their full cortisol production or otherwise our inflammation levels go up again.

If PMR is still "active" our inflammation levels go up rapidly and we "flare" if we aren't taking enough prednisone OR the adrenals can't produce enough cortisol.

There is no way to encourage the adrenals to produce more cortisol again EXCEPT a very low dose of prednisone. If we take prednisone for "too long" the adrenals may never produce cortisol again. What is "too long" depends on the person I guess. Many years of Prednisone wasn't too long for me but my endocrinologist said I got very lucky.

Thank you , you’re right about finding something that makes you happy which is difficult when one is feeling depressed .and fatigued. However, i forced myself to go for a walk today , which was painful and my legs felt heavy but my mood improved a bit .
I realised i have been looking to medication to cure me but need to change some things myself

After verifying that I could get 2.5 mg prednisone tablets at the pharmacy, I DID approach my rheumatologist about half mg tapering at my visit last week. I got the same reply as before, " I don't do that". His reasoning is that alternating whole mg amounts every other day is the same thing. I am now at 4 mg and doing ok. I'm going to stay at 4mg until I start PT in 2 weeks before attempting to alternate 4mg with 3 mg. ( not getting 2.5 mg tablets).
I had a visit with a 2nd rheumatologist in Jan who ordered the P T.
The endocrinologist I had been seeing has retired so I am exploring that option to address cortisol issues.

When I asked my doc for 2.5’s so I could avoid splitting when possible, she said “of course…how many do you need ?”
Some of them seem to sometimes forget that little things that make our lives a bit less complicated have value to the patient.

He adamantly does not want me tapering half mg incrememts.

Great explanation re stimulating adrenals to get working again. I’m at 3.5 and having trouble getting lower. I think I should just do it- go to 3 mg and put up with the discomfort to deprive adrenals and make them get busy. I hope they will comply! We’ll see…..

It is common to have discomfort for a while after dropping a level. Try some Tylenol. Do something to engage and distract you. Hang in there. It will get better !

I had to remain on 3 mg for about 6 months. My 8 a.m. cortisol level was too low. An endocrinologist said it wouldn’t be safe to taper any lower than 3 mg. I needed to wait for my cortisol level to improve and fortunately it did improve.

The only reason I didn’t have a flare was because Actemra kept PMR at bay. I’m off prednisone now but I still need Actemra.

I have had tremendous difficulties going below 5mg. When you say you alternate what do you mean? One day 4mg and one day 3mg? Back and forth?? How long?

There are various ways to taper Prednisone by doing an alternating dose reduction. I don't know how successful they are but it should be discussed with your doctor. Some doctors believe doing it this way is beneficial. The following link talks about tapering with alternate day dosing.
https://www.verywellhealth.com/does-prednisone-tapering-minimize-withdrawal-190242
"When people first decrease the prednisone dose, it is common to feel achy or fatigued.4 These symptoms usually get better within two to seven days. If withdrawal symptoms continue beyond a week, talk to your healthcare provider.

Sometimes, your healthcare provider may temporarily increase the dose and taper more slowly. Even so, some people may still experience symptoms.

One way to deal with this is with a technique called alternate-day tapering. For example, instead of lowering the dose from 4 mg to 3 mg, for instance, a healthcare provider may prescribe 4 mg one day and 3 mg the next day, alternating back and forth for one week.

If that's successful, you may be prescribed 4 mg one day and 2 mg the next, and so on, until you are eventually alternating between 4 mg one day and no dose the next. The healthcare provider would then gradually taper the 4-mg dose".
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I think the theory is to not take Prednisone every day. On the day with no Prednisone that might give a nudge to the adrenals. When I was ready to get off Prednisone, I did a "countdown taper." I did 3 mg one day --- 2 mg the next day and 1 mg on the third day then zero for a day before going back to 3 mg for a couple days. I did that many times just to see how I would feel in preparation for stopping prednisone altogether.

When I felt ready, I did one final countdown and stopped taking Prednisone. I only did this after informing my endocrinologist. She said give it a try to see what happened. When my countdown tapers went well and my cortisol level was "adequate," my endocrinologist thought it might be safe to discontinue Prednisone. However, she told me to "restart Prednisone again for any reason if I felt the need." My countdown tapers gave me some degree of confidence that I could safely stop Prednisone. It worked for me. Prednisone was my security blanket after taking it for 13 years. I wasn't in a rush to give up prednisone but now I'm very happy to be off Prednisone. The added bonus was how many other medications were discontinued in the years after I stopped taking Prednisone. Getting off all my blood pressure medication, cholesterol medications and several more made me feel even better.