1. < Polymyalgia Rheumatica (PMR)

PMR tapering

Posted by bonitatan846 @bonitatan846, 1 day ago

I am new to this forum. I had to cut winter vacation short and head home because of aching shoulders, hips and lower back aches and was in constant pain from Dec. 1st to Jan. 20, 2025. I am waiting to hear from a rheumatologist which could take months. All blood work came back normal because they had started me on 15 mg prednisone in January 2025. Since then I have tapered down to 2.5 mg. In the past 3 weeks I have been in constant pain and went back up to 5 mg (my NP is away) and within a day noticed a big difference. My question is how long should I stay on the 5mg before tapering down again. I did not get any help from my pharmacist.

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Mike | @dadcue | 1 day ago

It sounds like 5 mg is your "lowest effective dose." To be at 5 mg already after starting at 15 mg in January 2025 is doing extremely well. It isn't always about tapering your dose lower. My rheumatologist told me to find a "stable dose that worked" when I was newly diagnosed with PMR. I don't think a stable dose of 5 mg for a few months will do much harm. I assume you have enough prednisone to stay on 5 mg for awhile. If not, your primary care doctor should be able to tell you what to do until you see a rheumatologist.

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bonitatan846 | @bonitatan846 | 1 day ago
In reply to @dadcue "It sounds like 5 mg is your "lowest effective dose." To be at 5 mg already..." + (show)
@dadcue

It sounds like 5 mg is your "lowest effective dose." To be at 5 mg already after starting at 15 mg in January 2025 is doing extremely well. It isn't always about tapering your dose lower. My rheumatologist told me to find a "stable dose that worked" when I was newly diagnosed with PMR. I don't think a stable dose of 5 mg for a few months will do much harm. I assume you have enough prednisone to stay on 5 mg for awhile. If not, your primary care doctor should be able to tell you what to do until you see a rheumatologist.

Jump to this post

Thank you for your input. When you say to stay on for “a while”, do you mean a month or more? I was going to take the 5 mg for a week or two and see how I feel, then go down to 2.5mg, but maybe that is too soon?

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Mike | @dadcue | 1 day ago
In reply to @bonitatan846 "Thank you for your input. When you say to stay on for “a while”, do you..." + (show)
@bonitatan846

Thank you for your input. When you say to stay on for “a while”, do you mean a month or more? I was going to take the 5 mg for a week or two and see how I feel, then go down to 2.5mg, but maybe that is too soon?

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"A systematic examination of the peer-reviewed literature, which included 30 studies, found that most patients seemed to achieve remission of PMR with a starting dose of prednisone at 15 mg/day. A slow tapering of the prednisone, less than 1 mg/month, was associated with fewer relapses. Once prednisone is tapered to 10 mg/day, a further slow taper by 1 mg every 2 months until treatment discontinuation was associated with optimal control of disease activity."
https://emedicine.medscape.com/article/330815-treatment
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It would be better to see what your doctor recommends. However. staying on 5 mg for a month or two is reasonable. You really need to have 1 mg tablets when your dose is less than 10 mg.

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1 reply
bonitatan846 | @bonitatan846 | 1 day ago
In reply to @dadcue ""A systematic examination of the peer-reviewed literature, which included 30 studies, found that most patients seemed..." + (show)
@dadcue

"A systematic examination of the peer-reviewed literature, which included 30 studies, found that most patients seemed to achieve remission of PMR with a starting dose of prednisone at 15 mg/day. A slow tapering of the prednisone, less than 1 mg/month, was associated with fewer relapses. Once prednisone is tapered to 10 mg/day, a further slow taper by 1 mg every 2 months until treatment discontinuation was associated with optimal control of disease activity."
https://emedicine.medscape.com/article/330815-treatment
-------------------------------------
It would be better to see what your doctor recommends. However. staying on 5 mg for a month or two is reasonable. You really need to have 1 mg tablets when your dose is less than 10 mg.

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Thanks again for all the info, which I will talk to my NP about.

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richardab | @richardab | 16 hours ago

I just went from 5 to 4 mg and I’m feeling more pain and stiffness every day. My oncologist told me to check with my rheumatologist, he said 4 to 5 mg is what the Adrenal gland should produce every day. After taking Prednisone long term and at higher doses that that, the Adrenal may not be functioning yet and the body is deficient, which is a serious condition.

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art43 | @art43 | 14 hours ago
In reply to @richardab "I just went from 5 to 4 mg and I’m feeling more pain and stiffness every..." + (show)
@richardab

I just went from 5 to 4 mg and I’m feeling more pain and stiffness every day. My oncologist told me to check with my rheumatologist, he said 4 to 5 mg is what the Adrenal gland should produce every day. After taking Prednisone long term and at higher doses that that, the Adrenal may not be functioning yet and the body is deficient, which is a serious condition.

Jump to this post

Below 5, consider decrementing at 0.5 per month. By 1 at that point is often too much, according to most experiences documented here.
Be alert for adrenal insufficiency or (especially) adrenal crisis symptoms.
Also…some pain is normal, and is often/usually not PMR at this level.

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jillkellyauthor | @jillkellyauthor | 12 hours ago

A lot may depend on your experience with side effects. I tapered up to 8 mg, got full relief from the pain but also got major weight gain, vertigo, jitteriness, anxiety. All gifts. So I'm down to 5 and tapering a half mg every two weeks. I want off!

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