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The lowest effective dose, how is it defined?
Polymyalgia Rheumatica (PMR) | Last Active: Feb 24 7:53pm | Replies (97)Comment receiving replies
I was just thinking about "minimum effective dose." It really depends on the stage you are at in your journey and your personal situation.
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As you say:
"I'm hoping the small daily fluctuations while reducing more closely mimic natural daily cortisol fluctuations so we can sneak past the body's patrol system."
Yes.. assuming the problem is only adrenal insufficiency
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However ... as you say:
"No need to roll out the alarm response, business as usual."
This assumes the beast of PMR is no longer a threat. If PMR is still a threat, you may need a "fight or flight" response to a potential flare. Consider taking more Prednisone since you won't get much help from your adrenals.
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Another possibility is the beast of PMR is only stalking you. Your stress level is still high but PMR isn't an immediate threat. In that case ... it is hard to know what to do!
All to say ... there is no minimum effective dose. It just depends on your situation at the time. It can be a combination of many things that dictate what Prednisone dose you need. Your HPA axis won't be very helpful with adjusting your cortisol level according to your need.
Replies to "I was just thinking about "minimum effective dose." It really depends on the stage you are..."
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Yes, I mostly agree with you on those points. All the instructions on taking prednisone say to get to the "minimum effective dose", so that was my earlier goal. It seems to be a thing. But then as someone said earlier, it's a moving target. And PMR patients are pushed to keep reducing prednisone and get off it, so the minimum effective dose goes out the window anyway. We'll get pushed to reduce till we have a flare, then someone will suggest we add more drugs with more side effects. No fair!
My minimum effective dose last year was 7mg before the flare at 6.5mg. Since the dose rise to control the flare, so far this reduction attempt, the minimum effective dose is 5.5mg with no problems at all. I suspect my PMR may have run its course and hopefully I can keep going lower, slowly to both avoid waking up the PMR, and to wake up my adrenal glands.
I've done a few things differently this time and have no idea if any of them have helped, but I suspect the PMR may be winding down because the inflammation has been controlled by prednisolone for a good while now. I'm not stressing as much about it all now either, just keeping busy and doing things day by day.