The lowest effective dose, how is it defined?

That's what I hope too! 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. "Is everything okay here guys? Yeah, looks fine and normal. No need to roll out the alarm response, business as usual." 🙂

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.

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.

You have got this ... you can do it!

I truly can empathize with you. I just "encourage"people to take less prednisone if they can. Other people encourage you to take more Prednisone for niggles of pain ... whatever that means.

It is impossible to know what to do most of the time. I just know that I didn't ever need any encouragement to take more Prednisone. I was very good with that part of it.

That 7 mg level is a tough one. You might need to flip the narrative. Nobody will say take less than the minimum effective dose if you expect your adrenals to recover.

I was told 3 mg was the "minimum safe dose" I should take when I reached that level. That was what my endocrinologist said to do with precautions in place. The main precaution was to take more Prednisone for "any reason if I felt the need" but check with my endocrinologist first.🤔

Yes, everyone is different. My rheumatologist started me at 10 mg, which seemed low and it took several weeks to eliminate the pain completely. I asked if I needed a higher dose, but he said to be patient. Sure enough, I eventually became pain free and shot on past that to superwoman. I went from feeling 100 years old to feeling 30 years old (I was 68). He then had me taper at my own pace. With the help of the online community, I decided to do the dead slow taper and had no problems until I hit 1.5 mg. Then I had bilateral back pain for a few days. Then it went away. At .5 mg I had right knee pain for a few days. Then that went away. I never increased my dose or took any other pain meds. I have been prednisone free now for 7 weeks with no issues except morning stiffness. I am 70 and feel it, but nothing like PMR. I hope my experience is useful to someone. Dr. Bravo did me right!

Thats wonderful! Just curious how long you took prednisone and how long it took you to taper off? How long did you experience your PMR symptoms? I’ve been on it for almost 2 months. I was started on a very low dose of 4 mg and I am completely pain-free at that dose. I see my rheumatologist next week and I’m hoping and praying that he starts tapering me because I want to be off of prednisone completely.

I had PMR symptoms for about 4 months before I finally got a referral to a rheumatologist. The GPs didn't know anything about PMR, but the rheumatologist diagnosed me in 5 minutes. I took the 10 mg dose for a couple of months and then began to taper, 1 mg until I hit 5 mg. Then .5 mg until the end, about a year and a half. I have never heard of an effective dose of 4 mg. Awesome that it worked for you. That should mean a shorter taper. Good luck!