If you drop your dose below the level required to eliminate the inflammation from the PMR, then inflammation will build up again and pain will result. The steroids don't cure the PMR, just control the symptoms. And, like you, I don't think methotrexate does much good for the majority of us. So really we are taking the steroids for relief while waiting for the PMR to go away.

The risk is that if you drop the steroids too fast and too low that the level of inflammation that builds up will need an even higher dose of steroids to get rid of it and then you get into a yo-yoing pattern of going up and down. Small cautious steps in reducing dosage are the best way long-term. You are also at the level where your adrenal function needs to kick in and start carrying some of the load naturally so that can cause issues as well because that process can be very slow as well. It is a complex and very confusing illness to manage.

That's a very fast reduction schedule at 1mg every two weeks, especially under 5mg. Most often reductions are made every 4 - 8 weeks to avoid pain, give the PMR time to resolve, and give your body time to resume its own cortisol production. Your doctor's suggestion to return to 5mg and then alternate 5mg with 4mg would give a reduction of .5mg rather than 1mg, which makes sense if you have pain returning. Reducing by smaller increments and taking it more slowly is usually better.