1. < Polymyalgia Rheumatica (PMR)
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Down to 1mg prednisone and then extreme fatigue sets in.

Posted by allinge @allinge, Jun 20, 2025

I was diagnosed with PMR in January after ending up in emergency with extreme pain and unable to walk. In the hospital they gave me Prednisone 35-40 mg and an hour later, I felt such relief. Over these past months I've tapered down to 2mg last week and then to 1mg three days ago. Suddenly I'm in pain all in my legs, arms and back. I upped to 2mg but no relief yet. The strange thing is how extremely tired I've become in the mornings and the pain doesn't subside till late afternoon. Just wondering if anyone else has experienced this?

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brushetta13 | @brushetta13 | 1 day ago
In reply to @dadcue "@brushetta13 It took about a year for my overwhelming fatigue to dissipate when I was tapering..." + (show)
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@brushetta13

It took about a year for my overwhelming fatigue to dissipate when I was tapering off prednisone. An endocrinologist wanted me to stay at a dose of 3 mg or less while I waited for my cortisol level to improve. I took Prednisone for 12 years so the endocrinologist forewarned me that it would take time for my adrenal function and overwhelming fatigue to get better.

My PMR pain was being controlled by a biologic. The biologic made it much easier for me to stay at 3 mg or less while not attempting to taper off prednisone completely. The biologic didn't suppress my adrenal function while controlling PMR pain.

It took time for my cortisol level to improve. One clever way for me to tell that my adrenal function was improving was my "recovery time after exercise." When your adrenal function is compromised, your body struggles to produce the cortisol needed to mobilize energy. Healthy adrenal glands should increase their cortisol production during periods of increased activity to help mobilize energy. If cortisol levels don't increase any amount of activity will cause exhaustion during and after the activity. How quickly exhaustion occurs during activity followed by a prolonged recovery time are an indication that your adrenal function isn't good.

Everyone's adrenal recovery timeline is different after long term Prednisone -- often taking anywhere from 6 to 24 months. You can monitor your adrenal recovery by noting positive changes by gradually lengthening the time of an activity and the shortening of recovery time after the activity.

I'm using the word "activity" instead of exercise. An exercise work-out might not be feasible so any activity will do. When my overwhelming fatigue decreased and my PMR pain was controlled ... then I was able to discontinue prednisone. Just to make sure ... the endocrinologist checked my morning cortisol level.

It is a complicated process to discontinue Prednisone after long term use.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12378006/

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Thank you for this insight on the reduction of prednisolone.
I am back on 2mg a day, and feel much better. Your right about any
activity. I can walk up the stairs not holding on to the bannister. Bonus.
As they say there are always other people who are worse off. So I will not
complain about my length of time on the drug.
It really does help to discuss and read how we all deal with it.
Stay strong.

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rooster65 | @rooster65 | 16 hours ago
In reply to @kjoed53 "Reduced adrenal function causes fatigue. I'm in the process of tapering down by necessity and I..." + (show)
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Reduced adrenal function causes fatigue. I'm in the process of tapering down by necessity and I plan to discuss hydrocortisone pills for when I get under 10mg. I'm currently at 15mg and decrease to 12.5mg next week.

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@kjoed53

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rooster65 | @rooster65 | 16 hours ago

I also experienced extreme fatigue. I recently started taking Magnesium Citrate in morning & Magnesium Glycinate before bedtime and after couple weeks my energy level has become much increased. I can do exercises, stationary bike and some yard work( all in moderation)
Lots of water too.

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csimmonds | @csimmonds | 1 hour ago

Reading you posts is sort of comforting, I guess. I was diagnosed with PMR in March 2025 and have been on prednisone tapering until I stopped several weeks ago. Tapering at the end is really difficult and I tried to take is slowly. When I finally stopped I felt ok but now I am starting to have more pain at night and it lasts longer into the day. Also I have started feeling it in my back and (oddly) in my right hand. I don't know whether to go back on prednisone and if so at what dosage. I have some at various mg. Is it a flare up or just still have the basic PMR? My problem is I am between rheumatologists. I decided to change and recently got a referral for a new one. I am cancelling appointment with old one and haven't made one with new. Don't know how long I will have to wait but she doesn't know me yet. I am also having fatigue. None of my doctors ever talk about effects on cortisol and adrenal glands. Do other doctors discuss that with you. I only have one adrenal gland but my cortisol level was ok when I had it checked, however that was years before PMR. As I write this it is 9pm and I feel fine but I dread going to bed. I will go to sleep just fine but wake up after an hour or two and feel pain and stiffness so bad it hurts to roll over in bed. Then morning is bad too. Such a terrible cycle. My main pain is the top of my shoulders and the hip area, although it feels like pain in my hamstrings. Bending over and going upstairs is painful.

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