Connect
← Return to Better to be in some pain or better to up the dose of prednisone?
Discussion
Better to be in some pain or better to up the dose of prednisone?
Polymyalgia Rheumatica (PMR) | Last Active: Aug 21 12:56pm | Replies (80)Comment receiving replies
I started at 25mg. in December and was going down once per month till two months ago, when I was told to go down by 1 mg every two weeks instead. Ten days ago, with no problems I went down from 8 mg to 7 mg. Now for the first time I am waking up with painful and stiff right wrist and arm nearly to shoulder, some pain in hips and between shoulder blades. I had acupuncture in the shoulder a week ago and all of the pain vanished for a week. Here is my question: The rheumy said to call him if I had a flare-up and we'd discuss going back to the higher dose. But I am unsure of what consists of a flare-up. How severe does the pain have to be to call it a flare-up? After I get up in the AM, have coffee, breakfast and do my chores, by 9 AM the pain is nearly all gone for the rest of the day. It stays away till about 9 PM before I can feel it creeping back. Would a flare-up also do this, or am I not gauging things the right way? So, its just that before I call him, and I will if I must, I really want to know more about how one would describe a flare-up, is it any creaks and pains when you've had none heretofore, from going down to the lower dose? Or is a flare -up defined as being as severe, or nearly as severe, as what you came in for in the first place? Anyone who can help me define this, I will be grateful. Thanks. I would rather live with some pain and reduced dosage than have to go back up again.
Replies to "I started at 25mg. in December and was going down once per month till two months..."
Reducing by 1mg every two weeks is a fast taper, more likely to bring on a flare. A flare is a return of PMR inflammation and pain. After each reduction, some slight pain which passes within a week or so is common. But pain which gradually - or suddenly for some people - gets worse and doesn't resolve is a flare.
The Australian guide for reducing prednisolone/prednisone (under 10mg) is to reduce by 1mg every 4 - 8 weeks. The slow taper is to keep inflammation controlled consistently and long enough for the PMR to resolve, and to avoid steroid withdrawal.
At doses below 4-6mg (the amount of cortisol the body normally produces) adrenal insufficiency can become an issue for some people. At doses higher than that, the return of pain is more likely to be from the PMR re-emerging or from steroid withdrawal from reducing too quickly.
The aim is to keep inflammation and pain controlled consistently as we reduce dose. Your chances of achieving that while reducing at 1mg every two weeks are slim. Swinging up and down in dose in response to flares from reducing too quickly can result in a higher cumulative dose than reducing slowly and steadily, so fast reductions can be counterproductive.
Connect
Flares are very hard to define. Many people get tripped up at that 7 mg dose of Prednisone. I suspect something else happens at 7 mg because pain returning at 7 mg is extremely common and can't be just a coincidence.
My first question would be whether the pain is similar or the same as your symptoms when you were first diagnosed? Typically the pain isn't the same in terms of location, severity, etc.
What I would consider a flare is when the pain is relatively the same. Flares might not be as severe at first but with time the pain gets worse and not better. Flares can usually be distinguished from prednisone withdrawal symptoms because flares get worse. Withdrawal symptoms tend to get better in a few days after a decrease in dose.
Some people would rather not live with any pain so they increase their dose and call it a flare. When I did that, my rheumatologist didn't care but she would rather that I let her know before I increased my dose.
When I didn't know if it is a flare or not ... I let my rheumatologist know via a short, concise and non urgent message. Typically, my rheumatologist would respond in a day or two and want my inflammation markers checked before I increased my dose.