1. < Polymyalgia Rheumatica (PMR)
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Smallest amount of prednisone for adrenal glands to work again?

Posted by grandmap @grandmap, Jan 2 9:12am

I was diagnosed with PMR in May 2025. After 7 months of being on prednisone, I was able to taper off completely, but then had a flare on 12/15 after being completely off of prednisone one week. My rheumatologist had me go back on 20 mg and taper down again, 5mg every 3 days. I'm completely off now, but am having major issues with adrenal insufficiency, especially fatigue and night sweats. Is there a minimal amount of prednisone that I can take to alleviate these symptoms, while still allowing my adrenal glands to kick back in naturally in the next 6-12 months?

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staylorrn2000 | @staylorrn2000 | Aug 20 3:58pm
In reply to @54pontiac "@staylorrn2000 ‘You look good on paper’! That comment would send me running to another doctor. Bloodwork..." + (show)
Profile picture for 54pontiac @54pontiac

@staylorrn2000 ‘You look good on paper’! That comment would send me running to another doctor. Bloodwork is a very blunt and inexact instrument. If a doctor discounts how you feel in preference to numbers on a page, they are not a good doctor, in my opinion.

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@54pontiac , I sent my endo a message yesterday about this constellation of symptoms I’m dealing with again since a decrease and this is the message I received back from her. Well she finally got around to saying it!

“The symptoms that you associate with this are likely caused by something else, maybe anxiety.
The dose of 0.5mg of prednisone cannot give these issues.

As we discussed before, you cannot have adrenal insufficiency when you are on a dose of prednisone more than 5mg.
I see your labs from today, from last week, there are no abnormalities.
Not sure what is causing you this anxiety.”

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staylorrn2000 | @staylorrn2000 | Aug 20 4:04pm
In reply to @kjoed53 "@dadcue Both are corticosteroids, but they differ in potency, duration, and side-effect profile. Hydrocortisone more closely..." + (show)
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@dadcue
Both are corticosteroids, but they differ in potency, duration, and side-effect profile. Hydrocortisone more closely mimics our natural cortisol and causes less adrenal suppression than prednisone. It also has less effect on bone density. It's not supposed to treat PMR as it should only be used to treat the adrenal insufficiency that can occur with long term prednisone use, and as a means of ending prednisone use. For some people, the bone loss from prednisone use is a serious concern and hydrocortisone would be preferable for them. It's an option that should be considered if bone loss is a concern or if elimination of prednisone is preferred.

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@kjoed53 , I tried hydrocortisone and couldn’t tolerate it so went back to prednisone.

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kjoed53 | @kjoed53 | Aug 21 9:57am
In reply to @staylorrn2000 "@54pontiac , I sent my endo a message yesterday about this constellation of symptoms I’m dealing..." + (show)
Profile picture for staylorrn2000 @staylorrn2000

@54pontiac , I sent my endo a message yesterday about this constellation of symptoms I’m dealing with again since a decrease and this is the message I received back from her. Well she finally got around to saying it!

“The symptoms that you associate with this are likely caused by something else, maybe anxiety.
The dose of 0.5mg of prednisone cannot give these issues.

As we discussed before, you cannot have adrenal insufficiency when you are on a dose of prednisone more than 5mg.
I see your labs from today, from last week, there are no abnormalities.
Not sure what is causing you this anxiety.”

Jump to this post

@staylorrn2000
I don't know if anyone with PMR would not be anxious tapering down on prednisone. People who have never had PMR just can't understand what full blown PMR feels like!

REPLY
Profile picture for 54pontiac
54pontiac | @54pontiac | Aug 21 11:58am
In reply to @staylorrn2000 "@54pontiac , I sent my endo a message yesterday about this constellation of symptoms I’m dealing..." + (show)
Profile picture for staylorrn2000 @staylorrn2000

@54pontiac , I sent my endo a message yesterday about this constellation of symptoms I’m dealing with again since a decrease and this is the message I received back from her. Well she finally got around to saying it!

“The symptoms that you associate with this are likely caused by something else, maybe anxiety.
The dose of 0.5mg of prednisone cannot give these issues.

As we discussed before, you cannot have adrenal insufficiency when you are on a dose of prednisone more than 5mg.
I see your labs from today, from last week, there are no abnormalities.
Not sure what is causing you this anxiety.”

Jump to this post

@staylorrn2000 Wow. Just wow. If there is any anxiety, it is probably caused by that doctor totally dismissing you and also a common understanding of how adrenal insufficiency works. I hope you are able to try another doctor and show them that damning document. Good luck!

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potterywoman | @potterywoman | Aug 21 7:30pm
In reply to @bluebird25 "My story is similar to the questioner. I appreciate this answer. I am currently at 3mg..." + (show)
Profile picture for bluebird25 @bluebird25

My story is similar to the questioner. I appreciate this answer. I am currently at 3mg again after going down to 1.5 a year ago and experiencing great fatigue a flare. I went back up to 5 mg and had a good 4 months at that dose. I am taking my time and taking smaller steps this time. My doctor will only order bloodwork every 2 months and she is pushing for a taper to 2mg after 4 weeks at 3. I want to go slower after my experience last year.

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@bluebird25

My story is similar to yours. I originally tapered down and then off of prednisone for PMR a few years ago but recent assaults to my body (infected tooth oral surgery) triggered a flare for which i was prescribed 5 mg prednisone and tapered. I saw my rheumatologist not long after the surgery, and as my inflammation levels were still high, he said he would taper me more slowly. Finally off and after a while began to notice fatigue and some stiffness. The vague symptoms got worse with a couple of days experiencing extreme vertigo. I scheduled a visit and had inflammation levels checked again. He put me on a 2 mg dose until getting the results which showed increased levels, so he upped it to 5. He finally said the words adrenal insufficiency. My endocrinologist is checking my cortisol levels on Monday (today is Friday) to guide the taper. I strongly recommend seeing an endocrinologist as well as a rheumatologist unless your rheumatologist also checks your actual cortisol production. I would love to hear how you and others are managing getting through this treatment period. I have been able to do almost nothing but sit or lie around and am hoping that I will be able to get back to normal activity before much longer.

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