Typical dose of prednisone for PMR

My take and response to @maryjanecowell
1. A rheumatologist is not necessary for treatment
2. A GP or primary care can treat this (mine did) and has treated many others. Rheumatologists are hard to come by in the US and especially in the rural US
3. Wait times for any specialist are criminal in this country (USA) and either a month or 11 months is obscene. Nix the Rheumy
4. PMR can be but is not a lifelong condition. For most it is not.
5. PMR is NOT an autoimmune disease. There are no specific antibodies associated with it as a disease like RA. It is an immune modulated disease.
6. 40 mg to treat PMR is NOT a starting dose unless GCA is believed to exist and that is diagnosable with a high resolution picture of the eye by a Doctor of Optometry. Biopsy of arteries is controversial and dangerous.
7. Protocols for tapering and original dose are available papers such as the one below. An international meeting in 2015 set up standard treatment protocols. https://www.ncbi.nlm.nih.gov/books/NBK537274/.
8. Biologicals such as Kevzara should be considered as adjuncts to prednisone
9. The longer you wait to treat and get on with the plan the more pain your husband will be in . Pain is a waste of time and there is some belief/research(?) that says the longer you go undiagnosed and treated the harder it is to get over PMR and the longer you may have to be on prednisone.
10. Prednisone sucks but it does work for the vast majority of PMR people. Get on it, get feeling better and then follow the taper. Good luck

Most PMR patients start at something between 20mg and 40mg per day, then once symptoms are controlled and no pain they taper rapidly to something between 10 and 15mg per day. Tapering from that level is much slower with a goal to reduce the steroid to zero while not having a relapse of pain.
If you cannot get a sooner appointment with the rheumy then your husband should talk with his PCP about going on 25-30mg per day for 1-2 weeks to see if that manages the pain. If it does then the next step would be to taper down by 5 mg and stay there for one to two weeks. If not pain free then return to higher dose and wait for rheumy. If pain free then taper down 5 more mg. continue that until you get to 10-15mg and hold there for your rheumy. Because there is not a single standard of care that a doctor can follow treating PMR is much more individualized.
PMR is chronic, the hope is it that it will go into remission while being treated with prednisone. Prednisone is not a cure, neither is any other medication he might receive. There are biologic injections or other meds that allow you to get off the steroids. They too are anti-inflammatory treatments and are not cures. The advantage of these drugs is they allow you to not be on steroids, a real advantage due to steroid side effects.
There is not any cure for PMR, remission is the goal. PMR is a default diagnosis. Meaning if you do not have a host of other problems and you have PMR symptoms you will be Dx with PMR. There is no test for PMR.
I am sorry that he has PMR. It is a lifelong journey.

that is the typical dosing by a GP for treatment of say asthma or some short term anti-inflammatory. PMR as mentioned can be a more lifelong condition. It may not need treated lifelong. One of the tests to check for PMR can be the fact that prednisone works. He was started on 4-10's or 40mg. That can knock out about any inflammation. GCA tends to run with PMR. It would be important for your Rhumy appt to have them check for that. That diagnosis usually starts at 40mg to stop it. Prednisone replaces your bodies cortisol. This takes about 2 weeks for that to happen. Once your body stops making cortisol then the withdrawals are similar to PMR. You can generally move around with dosage in that first two weeks. That is why his GP is moving the dosage. I moved from 20mg to 10mg rather quickly and then had the pain return below the 10mg just as your husband did. 10mg controlled my PMR for 5 months then I was able to move to a lower dosage. You want to find his lowest possible dosage. That would appear to be the 10mg. Your question of is it really 4mg. Yes. Once the PMR starts to fade then he will need to move to lower dosages fairly slowly to allow his body to restart cortisol. the 4-6mg of prednisone becomes sort of the wall for your body to restart. Depending on how long he is on the steroids will impact his ability to taper. Many cannot get below the 4-6mg dosage. Newer biologics are usually tried to help with the taper. You can get prescriptions I think down to a .5mg. The pills can also be split.

If the pain returns when prednisone is at 20mg, then it seems that 25-30mg is the right dose. I started on 15mg but had to increase to 25mg for pain relief. See if he can stay on 25-30mg until he can see a rheumatologist. It's not an unreasonable request and a month into PMR is not very long.

There a few options for you in this situation, and it depends on what is available in your local medical system. Firstly, a one month wait to see any kind of specialist in our country today is actually pretty short. When I was diagnosed with PMR 3 years ago, the waiting time for a rheumatologist consultation was 11 months. Fortunately, I was able to see a general medical nurse practitioner on an urgent basis who was able to get my case reviewed by a rheumatologist via the medical record system. He agreed with the diagnosis, got me on the appropriate prednisone dose, recommended the appropriate blood tests and tapering schedule, and then everything went well managed by my PCP.

Alternatively, it would be totally reasonable for you to be treated for a month with the lowest dose of prednisone that keeps you pain free while you are waiting for the rheumatologist.

My take and response to @maryjanecowell
1. A rheumatologist is not necessary for treatment
2. A GP or primary care can treat this (mine did) and has treated many others. Rheumatologists are hard to come by in the US and especially in the rural US
3. Wait times for any specialist are criminal in this country (USA) and either a month or 11 months is obscene. Nix the Rheumy
4. PMR can be but is not a lifelong condition. For most it is not.
5. PMR is NOT an autoimmune disease. There are no specific antibodies associated with it as a disease like RA. It is an immune modulated disease.
6. 40 mg to treat PMR is NOT a starting dose unless GCA is believed to exist and that is diagnosable with a high resolution picture of the eye by a Doctor of Optometry. Biopsy of arteries is controversial and dangerous.
7. Protocols for tapering and original dose are available papers such as the one below. An international meeting in 2015 set up standard treatment protocols. https://www.ncbi.nlm.nih.gov/books/NBK537274/.
8. Biologicals such as Kevzara should be considered as adjuncts to prednisone
9. The longer you wait to treat and get on with the plan the more pain your husband will be in . Pain is a waste of time and there is some belief/research(?) that says the longer you go undiagnosed and treated the harder it is to get over PMR and the longer you may have to be on prednisone.
10. Prednisone sucks but it does work for the vast majority of PMR people. Get on it, get feeling better and then follow the taper. Good luck

That sounds way too fast for PMR. I assume you live in the UK, so the protocol might be a bit different, but surely not that much. That sounds more like the dose prescribed after many surgeries. It’s been a few years, but my original diagnosis was treated with something like 15 mg, then a week later, stepped down to either 12.5 or 10, then down 1mg per month at a time. Somewhere after going down below 5, it is not unheard of to have to go back up a mg and then try to taper again. This back and forth can continue over several cycles. This is a chronic autoimmune disorder. There may be flares. It took me a while to see a rheumatologist also but my PCP said she had “personal experience” with a similar disorder, so she was comfortable doing the treatment in the meantime. I had looked up the protocol on line on a professional site, and what she did was exactly what I had read, so I am guessing that she read the same source I did. The relief comes quickly but that doesn’t mean the inflammation is gone.

My take and response to @maryjanecowell
1. A rheumatologist is not necessary for treatment
2. A GP or primary care can treat this (mine did) and has treated many others. Rheumatologists are hard to come by in the US and especially in the rural US
3. Wait times for any specialist are criminal in this country (USA) and either a month or 11 months is obscene. Nix the Rheumy
4. PMR can be but is not a lifelong condition. For most it is not.
5. PMR is NOT an autoimmune disease. There are no specific antibodies associated with it as a disease like RA. It is an immune modulated disease.
6. 40 mg to treat PMR is NOT a starting dose unless GCA is believed to exist and that is diagnosable with a high resolution picture of the eye by a Doctor of Optometry. Biopsy of arteries is controversial and dangerous.
7. Protocols for tapering and original dose are available papers such as the one below. An international meeting in 2015 set up standard treatment protocols. https://www.ncbi.nlm.nih.gov/books/NBK537274/.
8. Biologicals such as Kevzara should be considered as adjuncts to prednisone
9. The longer you wait to treat and get on with the plan the more pain your husband will be in . Pain is a waste of time and there is some belief/research(?) that says the longer you go undiagnosed and treated the harder it is to get over PMR and the longer you may have to be on prednisone.
10. Prednisone sucks but it does work for the vast majority of PMR people. Get on it, get feeling better and then follow the taper. Good luck

Lots of good opinions and strategies here. You're at a fork in the road only your fork has multiple roads to take. If it were me, because I've been on this long winding road a long time, and hopefully 20 or 15mg is controlling the pain, I would attempt juggling the pills I have at the 20 or 15mg dose til the rheumatologist appointment if it's only a few weeks. Ask the GP for more pills at this dose to last til your appointment. Ask your GP about your plan before implementing it.
I had success in the beginning with getting a sooner appointment at rheumatology with a PA.
I have stuck with my rheumatologist since the beginning and my appointments are now every 6 months. A rheumatologist should/would be more aware of new treatment strategies. I had inflammation markers (CRP and SED RATE) done every month while the tapering road was 'rocky'. Now every 3 months.
If you have other medical conditions, your GP is invaluable. I'm seeing my PCP every 4 months.