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What is the goal when tapering?
Polymyalgia Rheumatica (PMR) | Last Active: 3 days ago | Replies (23)Comment receiving replies
At one stage I went up to 100 mg daily (for 5 days only) then down to 50 mg for a longer period to treat the rising inflammation of CRP (well over 100). It looked like I was starting to develop GCA symptoms and it was decided that hitting it hard was the best option. There was no formal diagnosis of GCA and no biopsy - I think largely because the high CRP told the story. It was a successful approach and possibly quite common. But tapering is hard and slow and I'm not eligible for Actemra as I don't have a GCA diagnosis. Coming up to nearly 2 years with PMR and after 18 months of methotrexate it see,s to have stopped doing anything at all, but make me feel worse for a day or so after taking it.
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"My understanding of the initial tapering is that there is an assumption that the starting dose of prednisone is likely to be too high. But it should mop up any accumulated inflammation and significantly reduce the impact of new inflammation being generated daily."
"At one stage I went up to 100 mg daily (for 5 days only) then down to 50 mg for a longer period to treat the rising inflammation of CRP (well over 100). It looked like I was starting to develop GCA symptoms and it was decided that hitting it hard was the best option."
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I'm sorry that you needed such a high dose of prednisone.
My ophthalmologist also told me to increase my prednisone dose to 100 mg more than 30 years ago but it wasn't to treat GCA, It was to treat uveitis which can also cause vision loss. There was no "mopping up" of all the accumulated uveitis inflammation with 100 mg of prednisone. The inflammation inside my eye decreased somewhat but I still couldn't see my hand in front of my face because of all the inflammation.
With uveitis you can actually see the inflammation inside the eye. I could see it and my ophthalmologist could visually see it. There was no need for inflammation markers. The inflammation didn't respond to prednisone like the mopping up analogy. I wish it was that simple.
https://www.mayoclinic.org/diseases-conditions/uveitis/symptoms-causes/syc-20378734
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Prednisone is used for a wide variety of inflammatory diseases. Rarely do these conditions respond rapidly to prednisone in a way that is thought of as remission. For PMR/GCA prednisone doesn't rapidly achieve remission either. The majority of the pain is relieved but that doesn't mean it stops the inflammation even on the day when prednisone is taken.
When my PMR was being treated, my rheumatologist was aghast that my inflammation markers were still elevated on 25 mg of prednisone after two years of treatment. For this reason, my PMR was called chronic and refractory and it never did "burned itself out." However, DMARDs and other things were tried so I wouldn't need so much prednisone.