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I think its great that you concerned about long term use. Most are just glad to be feeling alive again after starting prednisone. Usually our diagnosis took some time to figure out and feeling better on prednisone is a blessing. I was on 10mg equiv. for 5 months. Then started to taper. I was off prednisone in 6 months. My PMR was controlled and I did not have any other ailments that popped up. dadcue is a miracle. He was faced with so many demons to fight that he became a demon slayer. I agree with his advice. If you can treat PMR and prednisone as in a relatively short amount of time say less than 2 years then you can save yourself from additional medications. They all have some effect. Nothing like prednisone. Prednisone side effects may last a lifetime. (statiscally speaking). Educate yourself as much as possible and realize you can control the outcome.
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While Prednisone is known for its dramatic results, I have to say that it's Kevzara that has given me my life back. I had the usual dramatic response to Prednisone then couldn't reduce further. Unlike most folks, my response to Kevzara was immediate and dramatic. Within days, I had less pain and greater mobility. Kevzara targets different receptors than Prednisone, and I believe my PMR is more affected by that pathway. If I'm late with a Kevzara dose, my body reminds me. Meanwhile, I'm dropping to 3 mg of Prednisone this week and expect to be down to 1 and off by summertime. My exercise tolerance is (slowly) increasing, sleep is improved, brain fog from pain is almost gone. I'm much better off by every measure to be on only Kevzara than Kevazara+Prednsone. Can't wait to lose this moonface & weight gain and get back to walking and hiking 3 to 5 miles daily.
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I appreciate your kind words but I haven't slayed many demons. They still haunt me but I'm not so stressed out by my demons anymore. It took me a long time to realize that whatever is true for cortisol also applies to prednisone since the hormone cortisol is what Prednisone replaces. Long term use of Prednisone is not sustainable.
If I have learned anything it is that hormones are complicated. I now look at prednisone from an endocrinologist's metabolic point of view. You need a surge of cortisol (prednisone) in the short term when the treat is temporary. However PMR is a chronic, internal disorder that isn't likely to go away very quickly. Prednisone on a long term basis weakened me more that it helped me. Prednisone literally took away every ounce of energy I had in the longer term.
"In the primal sense of fight or flight, increased cortisol hormone raises the heart rate, increases mental alertness and makes you stronger, faster and smarter. However, it also slows other less needed system functions. The release of cortisol hormone tells the brain that sleeping, digesting food, burning fat and fighting bacteria are not that important. However, the new instructions are not sustainable for long-term health and wellness."
https://www.emetabolic.com/locations/centers/amarillo/blog/hormones-dna/constant-state-of-fight-or-flight-is-not-sustainable/