← Return to Better to be in some pain or better to up the dose of prednisone?

Discussion
Comment receiving replies
Profile picture for megz @megz

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.

Jump to this post


Replies to "Reducing by 1mg every two weeks is a fast taper, more likely to bring on a..."

When I was reducing I did a 1/2 mg every two weeks. I am at 3 mg and will stay there. I also have been on monthly infusions of Actemera. I have absolutely no pain. In rec states you can get the Actemera for more than a year. So good to have my life back!

You seem to know a lot about prednisone tapering and flares, so I thought I'd ask you. If I don't spot a flare and remain on my current dosage, reducing 1mg within the 4-8 weeks, will this hurt me? I ask because I am very active and often have pain. I'm a runner of 52 years, but have reduced my running to 3-4 times a week. The days I don't run, I walk. I also lift 4 days a week (lighter weights but hopefully will help prevent bone loss) and babysit a 19-month old who I pick up all day long, so I never know if the pain is overuse or PMR. I am down to 7mg and don't want to increase. I have some pain in the mornings again, but I can take a lot of pain as long as I can function. So.....thoughts?