PCP advising fast taper

Two things I want to address. I am definitely learning that PMR treatment and weaning is not an exact science. To address the question of doing your body harm by not taking prednisone I remember asking the rheumatologist exactly that and her comment was that the inflammation and harm to the body would not be in my best interest. She made the point with me when she mentioned it can lead to heart annd/or organ issues in long run. The second is I noticed that a post was in the string regarding NOT splitting dose of prednisone. When I asked rheumatologist at initial visit how to take my meds, I was told that taking all at once or splitting was really up to me and how it worked for my pain relief. To that answer I say that treating PMR is definitely “practicing medicine.

Two things I want to address. I am definitely learning that PMR treatment and weaning is not an exact science. To address the question of doing your body harm by not taking prednisone I remember asking the rheumatologist exactly that and her comment was that the inflammation and harm to the body would not be in my best interest. She made the point with me when she mentioned it can lead to heart annd/or organ issues in long run. The second is I noticed that a post was in the string regarding NOT splitting dose of prednisone. When I asked rheumatologist at initial visit how to take my meds, I was told that taking all at once or splitting was really up to me and how it worked for my pain relief. To that answer I say that treating PMR is definitely “practicing medicine.

Two things I want to address. I am definitely learning that PMR treatment and weaning is not an exact science. To address the question of doing your body harm by not taking prednisone I remember asking the rheumatologist exactly that and her comment was that the inflammation and harm to the body would not be in my best interest. She made the point with me when she mentioned it can lead to heart annd/or organ issues in long run. The second is I noticed that a post was in the string regarding NOT splitting dose of prednisone. When I asked rheumatologist at initial visit how to take my meds, I was told that taking all at once or splitting was really up to me and how it worked for my pain relief. To that answer I say that treating PMR is definitely “practicing medicine.

Chronic inflammation is bad but so is chronic Prednisone use.

There are other ways to treat chronic inflammation besides Prednisone. Until relatively recent research, prednisone was considered to be the "only option" for PMR. The belief that Prednisone is the only option is changing if not totally debunked. Biologics are being tried for PMR. Now the research shows that certain biologics might be better options than long term prednisone for PMR.

The problem with "long term" prednisone use is that it suppresses adrenal function and creates a scenario where it is extremely hard to taper off prednisone. I'm not sure how long you can safely take Prednisone but the research shows more and more ... not very long.
https://www.drugs.com/medical-answers/long-you-prednisone-safely-3561220/
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In theory, PMR is a self limiting disease for a year or two and doesn't cause any lasting harm.

PMR is generally manageable and the outlook with treatment is often excellent, allowing most people to live normal, productive lives. However, relying on it to resolve on its own within a short time frame and without potential lasting complications like those associated with GCA or long-term steroid use is not accurate.

Sometimes I think treatment with long term prednisone creates perpetual PMR symptoms when we attempt to taper off Prednisone.

@dadcue I’m going to ask my pcp about biologics. She has never mentioned this. I’m wondering if there are actually people who are cured permanently of PMR or it’s just in remission or it wasn’t the correct diagnosis in the first place.

I was treated 12 years with Prednisone for refractory PMR. When a biologic called Actemra (tocilizumab) was tried, I was off Prednisone in one year.

Actemra is FDA approved for GCA but "should work" for PMR. The biologic that is FDA approved for PMR is called Kevzara (sarilumab).

I'm an actual person with PMR and treated with Actemra. I have been off Prednisone for almost 5 years. My inflammation markers increase when my monthly infusion of Actemra is held for too long. I don't have any sudden relapses (flares) anymore. My symptoms are well controlled.

Many of my side effects from being on Prednisone for 12 years are improving. I don't seem to have any side effects from Actemra. I can't say Actemra "cured me." However, my rheumatologist says I'm "better off" being on Actemra rather than Prednisone for the rest of my life.

I think only a rheumatologist would consider a biologic to treat PMR. Sometimes, I have asked my PCP a question about Actemra. My PCP says I need to ask my rheumatologist because biologics are "out of my PCP's league."

Thank you @dadcue My PCP responded to my question and told me to increase Tylenol to 2 tablets 3x a day and report back in a few days. She also sent a prescription for more 1mg prednisone in case I need it later. She is a geriatric specialist, I assume she is familiar with this disease. I trust/hope she would consult with a specialist if she is not. I looked into seeing a rheumatologist but most require a referral.

Sounds reasonable to me.

Geriatric specialists are good doctors too. We all will need one eventually. I could probably use a geriatric specialist too except my autoimmune problems all started in my late 30s. Now that I'm 70 ... maybe I should consult a geriatric specialist.