Typical dose of prednisone for PMR

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.

@slh317 My rheumatologist here in Spain is also quite conservative in tapering the prednisone. I'd been tolerating the small decreases in dosage fairly well, until I tried to go below 2.5 mg. (Here in Spain they don't make 1 mg. prednisone. the Lowest dose tablets are 5 mg. and 2.5 mg., and the tablets are scored so you can cut them in half.)
Currently I'm alternating between 2.5 mg. one day and 1.25 mg. the next, but I'm struggling with blurts of cortisol that leave me shaking inside, and especially with the accompanying mood swings. This is the second time that I've tried reducing to this amount, and I'm running into the same wall.
I'm really glad to have found this group, if only to realize that I'm not alone on this journey.
Thanks for sharing your post.

@rugi53
FYI , Here in Pittsburgh we had a renowned rheumatologist who has a special interest in vasculitis, GCA, and PMR. Sebastian Sattui. He has relocated to Spain taking a position with Novartis. Probably now doing research and webinars. I sometimes Google his name and look for videos.

@rugi53
FYI , Here in Pittsburgh we had a renowned rheumatologist who has a special interest in vasculitis, GCA, and PMR. Sebastian Sattui. He has relocated to Spain taking a position with Novartis. Probably now doing research and webinars. I sometimes Google his name and look for videos.

@jabrown0407
I was initially put on 20mg/day by my primary care doctor until I could get in to see a rheumatologist which took a long time since they are booked solid. The rheumatologist lowered my dose to 15 mg and then 10 mg and then tapered 1 mg/day/month which took almost a year.
I believe my PMR was triggered by stress - I had just had knee replacement surgery when my mother became very ill 800 miles away so I had to cut my PT short and commute to another state to care for her. While away my husband got sick and was hospitalized so I was traveling back and forth on a new and still painful knee. My mother passed, my husband recovered and my knee healed so the stress was gone. I have not experienced that level of stress mentally and physically since then so that may be why I have not relapsed. My rheumatologist did say I was one of the lucky ones that has not relapsed or developed GCA but I still see her once a year for follow-up.
Everyone is different so what worked for me or what caused PMR to begin with depends on the individual. Best of luck to you in the future.

@pmrsuzie interesting too bad he left us. We don’t seem to be funding our great scientists again. Thanks. I will
Google him.

@pmrsuzie You're also not that far from the University of Pennsylvania in Philadelphia. They have a partnership with the Vasculitis Foundation and its research branch, the Vasculitis Patient Powered Research Network (VPPRN). They are a leading research center for vascular diseases including PMR and GCA, and have symposiums, online presentations, etc. I'm involved in a volunteer project with the VPPRN, even though I live in NC.

If anyone is interested in participating in research into PMR and GCA, they can register with the VPPRN at https://vasculitisfoundation.org/treatments-research/patient-powered-research/. They accept people from all over the world.

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