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what to expect when starting prednisone for PMR
Polymyalgia Rheumatica (PMR) | Last Active: 8 hours ago | Replies (58)Comment receiving replies
@csimmonds I am replying to my own post. This one is from almost a year ago so it is an update. I stayed on prednisone and tapered as rheumatologist recommended. By May I was at zero but being pain free didn't last long. I was changing doctors so waited to go back on prednisone. Fortunately I was able to see my new rheumatologist the end of June. He was very helpful in understanding where I was and what the future may hold--PMR is so unpredictable. He had me start taking 5mg of prednisone. It wasn't the immediate relief like when I started the first time but that was when I was taking 30mg. The 5mg gave a lot of relief but it took a few days for me to feel normal. I am now tapering every 2 weeks down to 2mg. I will stay on that until my next doctors appointment. So far so good. I do water exercises everyday but am still reluctant to push myself too much. I am confident my rheumatologist will be a good guide as I deal with PMR short term and long term. When I read the experience of others there seems to be no standard for the dosage of prednisone when first diagnosed. I was glad to start high initially but was relieved that when PMR returned I could start with just 5mg of prednisone. Is that the same with most people?
Replies to "@csimmonds I am replying to my own post. This one is from almost a year ago..."
@csimmonds No rules, it is all up to you. No one, MD or not seems to know the path or reasons.L
Yes, love water exercises, also, hot tub. I self tapered with agreement from Dr. so I stayed on a dose until I was pain free for at least 2 weeks.
My go to method is 15 mins of light exercise in bed before getting up. Saved me when I was crippled with PMR early on. Still do them to this day 2 1/2 yrs later. Mostly do them to prove to myself “I’m back!”
Now to address your question, I did not have a time off meds like you. However, I am on the biologic Kevzara and did go off for 2+ months, my blood work came back with increased CRP and SED numbers. DR. had me go back on Kevzara. At no time was I in pain, or discomfort.
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@csimmonds
Yes ... I think there are two approaches to the starting dose. You can start at a higher dose and decrease to find the "lowest effective dose." You can also start at a lower dose and increase as needed to find the lowest effective dose.
I think your first experience with taking 30 mg of prednisone and tapering down gave your doctors a better idea of where your lowest effective dose was. I agree that PMR is unpredictable but the lowest effective dose of prednisone is too.
Diagnosing PMR isn't an exact science. Depending on the what diagnosis is suspected and a person's risk of side effects also determines how much prednisone might be needed in the beginning. GCA starting doses are much higher than PMR starting doses for example. Weighing all the risks and benefits is important.
I like the following video that states that there is no "gold standard" for treating PMR.