It is so difficult to know what is going on when our Prednisone dose gets low.

Prednisone has a way of "masking" pain caused by osteoarthritis so that is certainly one possibility.

Adrenal insufficiency can also cause muscle and joint pain so that is another possibility.

A third possibility is an actual PMR flare.

It could be a myriad of other things that can cause pain when our prednisone dose is lowered.

I never thought inflammatory markers shed much light on anything given there are a myriad of additional reasons why inflammation markers may be raised. Even the excess weight I put on while I took Prednisone may have increased my inflammation markers.

I don't really understand what an ultrasound will reveal. There is no definitive diagnostic test for PMR so I doubt there is anything definitive to say if you are having a flare or not.

Let us know what your doctor decides when they make a decision.

I remember when someone suggested piriformis syndrome which supposedly is common with PMR explained my rather severe sciatic pain. That was far from the truth when an MRI revealed severe spinal stenosis in my lumbar spine.