When is it time to discontinue prednisone?

@rnm, You sound like you are doing well with your tapering off of prednisone. You do ask a really good question but I'm not sure there is an answer that is the same for everyone since it can be different for each of us with PMR. You mention that you still have some pain almost a year into your PMR diagnosis and starting prednisone. My first time with PMR lasted 3 and 1/2 years and the last six months was going back and forth between 1 mg and 1/2 mg before I could finally stop taking it. My second occurrence with PMR six years later and only lasted 1 and half years before I was able to stop taking the prednisone. I kept a daily log of my dose and pain level and my acceptable level of pain when I first got up in the morning was 2 or less on a scale of 0 to 10. I never used Tylenol or other OTC other than for headaches. My 2 or less level of pain generally got better after I got up in the morning and started my daily routine.

Here's some information that talks about it.
"While the aim is to stop prednisone use as soon as possible, the average duration of prednisone use is one to two years."
-- Polymyalgia rheumatica (PMR) – look before you leap: https://bpac.org.nz/2023/pmr.aspx

If you have time, @dadcue shared a great video that provides some understanding of the tapering issue.
-- Video: Steroids and PMR - International Panel of Doctors
https://connect.mayoclinic.org/discussion/video-steroids-and-pmr-international-panel-of-doctors/
Just curious, how would you rate the pain you describe as the pain you have been treating with Tylenol?

@johnbishop
My experience is, I ditto John’s info/advice.
Your path seems pretty fast.
I tried to get off drugs before my body was ready.

I was “finally” diagnosed in April 2024. (Guesstimate it started in January 2024) It’s now November 2025…and have all the symptoms/evidence that leads me to “believe” I’m on a 2 yr journey.

My mistake (🤔) was not starting Kevzara when the Dr recommended it (5 months earlier ) because I did not understand that it would help me get off of prednisone.
With that said, I am 4 months off prednisone, 7 1/2 months on Kevzara, now at delayed doses (every 3 wks not every 2 wks).

Note: I am a 79yo female used to all things outdoor and active which I have worked hard to get back too thx to this blog, my functional movement specialist, pool walking etc.

Good luck, keep asking questions.

I stayed at .5 for a month, then my doctor suggested that I only take it on my PT days. After a few weeks my PT days became fewer and farther between to the point that I realized that I'd gone 5 days without taking it. At that point I switched over to Tylenol.
I should warn you that in my case going to 0 mg was a difficult transition, I definitely had some sort of withdrawal process. But that passed, and now I sometimes find myself forgetting to take Tylenol with little to no consequences (unless I exercise too much). My total time from beginning to end with prednisone was around 16 months. It felt much longer.
I am a 71 year old female. I was sick for months before I sought help, and another several weeks to agree to prednisone,

My rheumatologist started telling me that I needed to be off Prednisone after a year or two. That is the amount of time that PMR is supposed to last and "burn itself out." My reheumatologist started introducing various "steroid sparing medications" after 2 years.

The focus of my rheumatologiy visits after 2 years was more about trying to get me off prednisone than about PMR. The inevitable first question my rheumatologist always asked me at every visit after 2 years was, "How much Prednisone was I taking?" The concern was less and less about my PMR symptoms and more and more about my cumulative Prednisone dose.

It was actually 12 years before I actually tapered off Prednisone. An endocrinologist changed everything about how I should taper. My rheumatologist facilitated my discontinuation of Prednisone by prescribing a biologic instead of Prednisone. Now it has been 5 years since I discontinued Prednisone.

@noti What is a "PT day?" Physical Therapy?

@superfly999 Sorry I should’ve spelled that out. Physical Therapy. My left upper arm had some sort of adhesion that caused it to be impossible to lift first thing in the morning, and would cause problems throughout the day.
It took months to finally loosen up.

@rnm. It appears that you may be one of the lucky ones that finishes with prednisone earlier than most on this forum. I have friends that have taken 3 months to get over PMR. Some have taken 6 months, others nine I think I may be one of the lucky ones too. I started my PMR journey in March of 2025 and am down to 3 mg. I am hoping to be done sometime this winter (January?). I am 63 years old. You must remember that folks on this PMR forum are helpful, but a biased sample of PMR patients. Many who have PMR do not have a long term case and are not searching for answers/help on this forum. We never hear from them. That said.....every case is different and there is some great info on this forum that can help ALL PMR patients. I do like @noti's idea of alternating days on the last .5 mg. Whatever you can do in terms of dosage to lessen the complete drop off. For example, I have gone to 1/2 mg drops these last few dosages because when you drop, each drop of 1 mg is a greater percentage dose reduction as you reduce. But I think that for me not having PMR pain right now while on 3 mg means that my issues are mostly (?) the adrenal gland getting started again. Some weird feelings with that. I may be more frightened now of the adrenal functioning than I am of PMR. Good luck.

@petermccarville
"Many who have PMR do not have a long term case and are not searching for answers/help on this forum. We never hear from them."
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This is a pity because I want to know why some people get over PMR so soon and others don't. Maybe I could learn something from them.

The only thing I have learned from 12 years of PMR was what Prednisone did to me for 12 years. PMR didn't seem to do any lasting harm. I distinctly remember telling a physical therapist, "Nothing could hurt that much without causing some damage." Now I know that PMR can be chronic but it didn't do any damage to my shoulders and upper body where PMR hurt the most. My lower body is a disaster zone but other things besides PMR can explain that damage.

What I have learned is that the primary treatment of PMR are corticosteroids (like prednisone) and the treatment can have significant side effects and long-term health implications. I'm so grateful that Actemra allowed me to taper off Prednisone after 12 years and things are getting better for me. Don't believe anyone that says Prednisone side effects are "easy to manage" and the "only option" for PMR.
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Have you seen the recent videos that Dr Megan the prednisone pharmacist has made about flares vs. withdrawal vs. adrenal insufficiency?

My doc. is reducing me by .1 every seven days.
I started at 15 and now down to 10.
Next week will be 9
Following week will be 8 and so on until I hit zero.
No big, issues other than minor nausea now an again.

I’m a reasonably healthy 82 year old, and respond forcibly to small doses, so a little over a year ago I started on 10 mg of Prednisone. That did the trick within hours. Then the doc had me slowly and steadily taper off and as of 6 weeks ago I’m Prednisone-free. So the taper took most of a year. Since then, various aches and pains have sprung up, confusing me: Relapse time? But the doc assured me the problems are from other causes. I almost think the fear of a PMR relapse is one of the causes. I hope you have a rheumatologist you can trust to guide you through this tricky period.