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With you being on prednisone for so long and at a reasonably high dose, you are probably experiencing low to no adrenal function. The symptoms of low adrenals are definitely malaise and odd pains here and there. Some even say it mimicked their symptoms. You probably need to get with an endocrinologist or a primary care Dr who understands adrenal function, or lack of. The fact that you got down to 4.5 mg says that you probably have some adrenal function. It is a mater of waking them up. There is a lot on this website that addresses adrenal function. I only had a little bit of fatigue/malaise when I came down and eventually off prednisone. I did, however, have all the odd pains and some that felt like PMR but they did not last nor progress and that said , to me, that they were not PMR coming back. I am not sure, by your post, if you had PMR but what you most likely have now is prednisone induced adrenal insufficiency. I am not the Dr, however! Just my 2 cents. Good luck.
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@petermccarville
I can't agree more!!!
I had a chance internet meeting with an amazing person who had an adrenal crisis because of her long term prednisone use. She wanted me to see an endocrinologist when I told her about my long term prednisone use. She could relate to everything I told her about all the difficulties I had with getting off prednisone. There wasn't much she could do but at least I was able to reverse course and I managed to get off prednisone. I had more problems with people who encouraged me to take prednisone for the rest of my life. I was never certain what "quality of life" that Prednisone offered to me.
The link below is the long preliminary dialog that I had with the person who had the adrenal crisis. We continued to exchange information via email before she died. I credit her with turning my life around. She renewed my quest to find an alternative to prednisone.
https://www.healingwell.com/community/default.aspx
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The endocrinologist I saw had a different perspective than my rheumatologist. However they both shared the common goal to get me off prednisone as soon as possible.