"Indefinitely" doesn't mean staying on a low dose of prednisone forever or for the rest of your life. Your struggle to stay on a low dose might be because your adrenals aren't producing enough cortisol to regulate the inflammation caused by PMR.

I think staying on a fixed low dose (3 mg or less) of Prednisone for an "indefinite period of time" was the final step for me to taper off Prednisone. The idea that I shouldn't attempt to taper lower than 3 mg was a foreign concept to me. It was what an endocrinologist told me to do when my 9 o'clock a.m.cortisol level was too low to taper any lower than 3 mg.

I had to wait 6 months for my adrenals to start producing "adequate" cortisol levels again. That is the indefinite part because for some it could be less than 6 months. For other people it could be longer than 6 months.

For me to stay on 3 mg of Prednisone was impossible until I started Actemra (tocilizumab). Without Actemra the pain for start up again and 10 mg and then then my level of pain would be top much at 7 mg.

I remember someone told me that Actemra "does nothing" that helps the adrenals to recover. I think they were wrong about that. It wasn't what Actemra did to stimulate my adrenals. It was more about how Actemra allowed me to stay on a 3 mg of Prednisone so that my adrenals were not totally suppressed by prednisone.

The endocrinologist I saw didn't know how long it would take for my adrenals to show signs of recovery. I think my adrenals only made a "partial recovery" when I was still on 3 mg of Prednisone. I think a "full recovery" happened when Actemra allowed me to discontinue Prednisone without a PMR flare.

I think it involves keeping PMR inflammation under control while we stay on a low dose of prednisone. For me Actemra did a nice job of keep PMR under control but maybe some other steroid sparring medication might also help with that too.