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

@petermccarville
There is I believe one other way to diagnose GCA, which is with "Color Doppler Ultrasound" also called "Power Doppler Ultrasound," or "Musculoskeletal Ultrasound. " It also can confirm PMR by looking at the shoulder. The Ultrasound Dr had to look at both my temples and sides of my head and maybe somewhere else I can't remember to check for the GCA. It's not like a regular Ultrasound and might need special training by techs, I'm not sure. Just in case no one knows about it. Don't know how easy they are to get in rural areas as mentioned though.
Unfortunately, in my experience, regular Dr's, NP's often have never heard of it, encountered it nor be very knowledgeable about dosing and tapering speeds etc. But every Dr is different. I hope everyone can get the help they need. This is a terrible disease.

@petermccarville
Obviously the GP is not familiar with PMR or they would not prescribe the course of prednisone as if it was a short term issue. I would not recommend treatment by any doctor not familiar with PMR.

@petermccarville love this post.. I’m just starting out on the journey after suffering for only about 3 weeks of the intense pain. 20mg initially got rid of my symptoms in one day. Luckily in UK i managed to see a very good Rheumatologist within a couple of weeks and he used 20mg to make the diagnosis as my bloods were normal. Now on 15mg for one week and then 12.5 and then 10mg for a period of one month to five weeks ( that’s the plan) … I’m 58 so apparently on the younger side to have this so I’m hoping that my quick diagnosis and general good health will help me taper in the way you described. I’m still very worried though and know that this can be complicated… thanks again for great post

When I had PMR with pain in my shoulders and hips my rheumatologist at UAB, one of the top rheumatology centers in the US, had me taper prednisone very slowly in order for my body to adjust and start making cortisol on its own again. I started at 20 mg then 15 mg then 10 mg/day for a month. I then tapered down from 10 mg/day by 1 mg/day each month. This process took almost a year to get to 0 mg prednisone but I have been in remission with no symptoms for the last 5 years. I had no side effects from the prednisone except that it gave me a lot of energy. I think many doctors taper down too fast.
My rheumatologist had me taper slowly: once I got down to 10mg the protocol was first month 10mg/day, second month 9mg/day, third month 8mg/day……until you get to 0 mg.

@kjoed53 . It is possible that the GP prescribed the prednisone as a test of PMR. Mine, who has treated many patients, did just that kind of blast. It is not only a test to see if one responds but also a hope that a short blast can knock it down enough. Kind of a "hail mary" type of move. I try not to instill doubt or question in a situation that I may not know what the motivation of the doctor was. They may have a perfectly sound reason. I think my main point is that PCPs, GPs, and primary care doctors can handle this kind of thing. Mine is a nurse practitioner and she is well versed in it. The local rheumatologist is 70 miles away. The only one in western Colorado and most likely would have declined to see me even if I wanted to. They have bigger issues to deal with in our area and PMR does not get the time of day, according to my primary care Dr. (nurse practitioner). Rural life has its issues. I would and did lots of self treatment with prednisone. I handled my own taper by following international protocols. My primary dr was available, mostly, via web chats . I kept her posted of my progress and what I was doing with my prednisone.

@boomermeg . Thanks for sharing that "other" method for diagnosing GCA. I have not heard of it but it could be or be similar to the doppler used in echocardiograms. I was going off of what my DR of optometry told me when we recently looked at a high resolution photo of my eyes. He said to stay away from the biopsy method as it has its issues. He explained to me that diabetes, heart disease, GCA, Uveitis, and other things can be diagnoses by looking at the small arteries in the eye with the high resolution photos or with a scope. It was quite a fascinating discussion. In addition, one can see if one had ever had GCA by the remnants in those arteries. Happy to say that his investigation of mine showed that I had been spared GCA during my PMR journey that ended in March of 2026. Amazing stuff.

@kjoed53 . It is possible that the GP prescribed the prednisone as a test of PMR. Mine, who has treated many patients, did just that kind of blast. It is not only a test to see if one responds but also a hope that a short blast can knock it down enough. Kind of a "hail mary" type of move. I try not to instill doubt or question in a situation that I may not know what the motivation of the doctor was. They may have a perfectly sound reason. I think my main point is that PCPs, GPs, and primary care doctors can handle this kind of thing. Mine is a nurse practitioner and she is well versed in it. The local rheumatologist is 70 miles away. The only one in western Colorado and most likely would have declined to see me even if I wanted to. They have bigger issues to deal with in our area and PMR does not get the time of day, according to my primary care Dr. (nurse practitioner). Rural life has its issues. I would and did lots of self treatment with prednisone. I handled my own taper by following international protocols. My primary dr was available, mostly, via web chats . I kept her posted of my progress and what I was doing with my prednisone.

@martyn. Good luck with the taper, Glad you have seen the Drs and are on your journey. Bloo work is usually normal when on Prednisone. It is a kind of marker that the dosage is right (in addition to pain level). At 63 I was able to do the taper in 10 months with no flares. I really paid attention to my body and noticed that at around 4-5 mg (6 months in) PMR was leaving my body. I could tell even while medicated. The journey was one of the more bizarre experiences I have ever had in life. Not to be repeated, hopefully. I also worked on calming my central nervous system via acupuncture and chiropractic in case a heightened fight or flight (sympathetic system) was at hand (which it usually is with me!). In addition, i worked with an Ayurvedic dr on any leaky gut concerns which may be linked to this and other diseases. I was an am into anything that can help.

@slh317 Tapering by 5mg even if you are staying at each level for a month is not what I would consider " very slow". Tapering my 1mg per month is slow. Two stages to the tapering process you described - Stage 1 - rapid taper to 10mg; Stage 2 - slow taper from 10mg to zero.
Your move from 20mg to 10mg took 2 months, then from 10 to zero at one month per level would take 10 months, exactly a year if all works as planned. You are lumping the move from 20mg to 10mg in the same category as moving from 10mg to 0mg.
You are indeed fortunate if you only needed one year of treatment. I am in year 7 and now have asymptomatic GCA with vascular damage requiring two different highly trained and sought after specialist to watch over my aorta and my neck and head to try to prevent a dissection.