Replies to I was diagnosed with PMR in February and finally got down to 5 mg with no…

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Polymyalgia Rheumatica (PMR) | Last Active: 6 days ago | Replies (18)

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@zkeith

I was diagnosed with PMR in February and finally got down to 5 mg with no pain. Someone on this board posted the Mayo Clinic protocol for tapering, so I am in the process of trying it. It is a slow process, which I believe is necessary. Perhaps whoever posted the Mayo Clinic protocol can repost it. In six weeks' time, I am now down to 4.5 mg. per day with absolutely no pain. In two more weeks, I will be going to 4.5 and 4 mgs. (alternating daily) for 3 weeks, and then to 4 mgs for 3 more weeks, and then 4.0 and 3.5 (alternating daily) for 3 weeks and then 3.5 for 3 weeks on then on down. The person who put the Mayo Clinic protocol on here did a much better job of describing the process than I have so I hope he/she will put it back on.

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Replies to "I was diagnosed with PMR in February and finally got down to 5 mg with no..."

Mike | @dadcue | Sep 17 11:26am

There is no Mayo Clinic protocol for tapering that I'm aware of. There are some guidelines that suggest a slow taper is better and to never discontinue Prednisone abruptly. There is no evidence based taper that works well for everyone so an individualized approach is the recommendation. The closest thing that comes to being evidenced based is the EULAR/ACR guidelines that were written in 2015.

I believe Mayo Clinic's guidance reflects and cites these widely accepted practices for treating PMR according to the 2015 recommendations by the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR).
https://pubmed.ncbi.nlm.nih.gov/26352874/
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The current debate focuses on whether or not treatment with long term Prednisone is the best treatment for PMR and GCA. It seems to have come as a surprise to the medical community that so many patients are unable to taper off Prednisone in a "reasonable amount of time." However, there is nearly universal agreement that "long term" Prednisone causes significant side effects.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9113421/#:~:text=A%20gradually%20reducing%20regimen%20of,suggest%20%5B10%2C%2011%5D.

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