Down to 1mg prednisone and then extreme fatigue sets in.

Posted by allinge @allinge, 4 days ago

I was diagnosed with PMR in January after ending up in emergency with extreme pain and unable to walk. In the hospital they gave me Prednisone 35-40 mg and an hour later, I felt such relief. Over these past months I've tapered down to 2mg last week and then to 1mg three days ago. Suddenly I'm in pain all in my legs, arms and back. I upped to 2mg but no relief yet. The strange thing is how extremely tired I've become in the mornings and the pain doesn't subside till late afternoon. Just wondering if anyone else has experienced this?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@megz

That's a very fast prednisone taper you've done - five months to reduce from 35mg prednisone to 1mg is most unusual. I'm surprised the pain didn't return sooner at a higher dose. Prednisone withdrawal can cause pain that can be indistinguishable from the PMR pain. Did your doctor order such an unusually fast taper?

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My Dr also said Pred withdrawal can cause similar pain. I’m down to 2mg and will drop to 1 mg in one more week. I’m in a lot of pain and fatigue with brain fog too. I’m going to soldier thru until I’m off it and beyond. I’ll remain on Actemra infusions until they can make up for not taking P. In some ways the Prednisone is worse than PMR.

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@aflik

I’m on the same taper schedule as you and also on Actemra 1 per month. Next week I’ll be down to 1 mg and after 3 weeks - off prednisone totally. I’m experiencing pain in the AM, brain fog and fatigue all day. I won’t go back. My Doc said I need to tough it out and feel’s that after withdrawal, Actemra will pick up the slack. Fingers crossed. 🙏

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"My Doc said I need to tough it out and feel’s that after withdrawal, Actemra will pick up the slack."
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Interesting way to phrase it but I would agree. It mirrors my experience when I tapered off prednisone with Actemra. My only suggestion might be an a.m. cortisol level prior to discontinuing prednisone. The a.m. cortisol level might be optional if you aren't having symptoms of a low cortisol level.

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@allinge

Tapering off, 1 mg every three weeks, was the advice of my doctor. I now have an appointment with him next week. I upped my dose to 3mg and am beginning to feel less pain. If I have to stay on that, so be it. There is a waiting list of a year before I can see a rheumatologist.

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The general advice for tapering is to reduce by no more than 10% of the current dose at a time, which means less than 1mg each reduction below 10mg. Some people reduce by 1mg per reduction till about 5mg, after which time .5mg reductions work better. (I started reducing by .5mg every 3-4 weeks at 7mg, for a 1mg reduction every 7wks or so.)

Advice (Australia) is to reduce by 1mg every 4 - 8wks under 10mg, depending on how an individual is tolerating the reduction. Slowly and surely can reduce the likelihood of flares and avoid the premature adding of other drugs which come with their own new side effects.

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@heals1225

Hey @boo3
Sorry to hear you went from tapering down to 2 then back up to 14. I’m currently with my second bout of PMR, approximately 10 years apart. Been on prednisone for two years now, which was my tapering time to be completely free of it 10 years ago. I am now on 5 mg this month, but was down to 2 in December until I had 3 excruciating days which brought me back up to 10. Have been tapering 1mg/month since February. Starting in July I will take @megz advice and taper .5mg/month using her schedule as well, and hope for the best. I wish everyone suffering with these symptoms all the best in their road to recovery!

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Thanks for the comments. I do believe after reading all the other posts that I may have been on an unrealistic schedule. Only started the 20 mg beginning of December’24 and not truly understanding the condition attempted weaning too much too soon. Rheumatologist not a big help but from what I see most of these posts state that they lower their doses by feeling. Trial and error. I golf (which I don’t do as much at this time) but still try with an Advil or two.

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@chpfireball

I had exactly the same problem with my hands, wrists and knees Was told it was OA, then RA but blood test don't support. I couldn't make a fist anymore or even button my clothes. I was put back on Prednisone 10mg for one month, then alternated 10 mg/5 mg every other day for two weeks. Now at 5mg for a month. I have some bad days that 1000mg have been able to work for the pain. Rheumatologist still has no explanation for the hand/wrist swelling and pain.

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The pain in hands seems to be in middle joints. Doesn’t hurt to touch but bending, or squeezing (fist) and holding something ((golf club) hurts. Advil or Aleve seems to help in days I want to golf or garden. Knees are off and on… learning to live with it until it gets figured out. Still blessed that I can walk my normal 3/4 miles a day for The most part but do seem to have less energy. I have been told that living with inflammation and the pain plays a part with energy.

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@chpfireball

I had exactly the same problem with my hands, wrists and knees Was told it was OA, then RA but blood test don't support. I couldn't make a fist anymore or even button my clothes. I was put back on Prednisone 10mg for one month, then alternated 10 mg/5 mg every other day for two weeks. Now at 5mg for a month. I have some bad days that 1000mg have been able to work for the pain. Rheumatologist still has no explanation for the hand/wrist swelling and pain.

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chpfireball… same here. As I posted in another string I was actually able to get down significantly from my starting point of 20mg but then found that my hands, knees and one wrist in particular hurt almost as bad as shoulders and hips did in the beginning.. Doctor originally stated that that was plain old osteoarthritis but one month later when I had had enough asked again and was told it COULD be PMR. So I upped the prednisone by 10mg’s and for most part pain has significantly subsided in hands and wrists. So what I was told was as probably OA could be PMR. Hoping to become better educated by belonging to this group.

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@boo3

chpfireball… same here. As I posted in another string I was actually able to get down significantly from my starting point of 20mg but then found that my hands, knees and one wrist in particular hurt almost as bad as shoulders and hips did in the beginning.. Doctor originally stated that that was plain old osteoarthritis but one month later when I had had enough asked again and was told it COULD be PMR. So I upped the prednisone by 10mg’s and for most part pain has significantly subsided in hands and wrists. So what I was told was as probably OA could be PMR. Hoping to become better educated by belonging to this group.

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Do you have regular blood tests to check inflammation markers? Two of the main inflammation markers for PMR are C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Most people (not all) will see a rise in CRP and/or ESR when PMR pain is present. Uncontrolled inflammation can harm the body. Don't let your doctor flick you off without investigating things properly.

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@boo3

chpfireball… same here. As I posted in another string I was actually able to get down significantly from my starting point of 20mg but then found that my hands, knees and one wrist in particular hurt almost as bad as shoulders and hips did in the beginning.. Doctor originally stated that that was plain old osteoarthritis but one month later when I had had enough asked again and was told it COULD be PMR. So I upped the prednisone by 10mg’s and for most part pain has significantly subsided in hands and wrists. So what I was told was as probably OA could be PMR. Hoping to become better educated by belonging to this group.

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I wonder if you had a full complement of blood tests. The sedimentation rate and CRP numbers are strong indicators that PMR is present. They did in my case, which together with my symptoms, gave my Rheumatologist and Primary assurance their diagnosis was correct.

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@boo3

Diagnosed in December by GP and he put me on 20mg of prednisone and relief was almost immediate. Over last six months have attempted to wean to lower doses, but found that I may have tried too soon. Original excruciating pain in shoulders and hips went away but then pain in hands, (fingers and wrists) and knees. Questioned rheumatologist about that and was advised that it was probably OA so I continued my weaning thinking that new pain was not related to PMR. WHEN I GOT TO ABOUT 2mg and realized pain was a bit over the top reached out again and was told that though PMR does not generally attack the hands and knees it was possible that it was the cause of that pain. Huh? Anyway back up to 14mg with lots of relief. Posting this so those new to PMR and prednisone can see that though our doctors are good they are still practicing and using this forum is probably the best way for all PMR people to make good judgements on their own and for themselves.

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@boo3 I have the pain in my hands and shoulders, every day is different… always painful…..diagnosed 12/28/24 down to 5 mg from 25 …. I don’t want to increase!
I love that there is a place that we can talk with people that have the same dx.
Very helpful 😊

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@megz

Do you have regular blood tests to check inflammation markers? Two of the main inflammation markers for PMR are C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Most people (not all) will see a rise in CRP and/or ESR when PMR pain is present. Uncontrolled inflammation can harm the body. Don't let your doctor flick you off without investigating things properly.

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Have had two blood tests. First in December 2024 .. CRP was 57 (normal 0-5) and ESR was 40 (normal 0-15). Rheumatologist retested in April of this year and numbers dropped to CRP- 3 and ESR-2 both within normal range so started to wean. Looking back at my daily notes and reading some of the other weaning journeys I do believe I may have gone down to much too quickly.

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