What steroid dosage did you start on? Did you find the right dosage?

Posted by abbeyc @abbeyc, Feb 5, 2022

Hello I am wondering what dosage of Prednisone everyone started on and how long (days) did it take to get complete 100% relief (if ever). Or how long did it take to find the right dosage? I have trialed 3 different steroid doses (with help from my doctors) for the past month and no success yet controlling all the pain 100% or determining the right dosage for me. Maybe I'm impatient.

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@johnbishop

Hello @patzmar, Welcome to Connect. My Mayo Clinic rheumatologist who diagnosed my PMR started me at 20 mg prednisone. If you have PMR I think the starting dose of prednisone is usually between 12.5 and 25 mg according to the latest recommendations. Here's some information that discusses the topic:

"The mainstay of treatment of PMR is oral prednisone therapy.29 According to the latest EULAR/ACR guidelines, prednisone therapy should be within the range of 12.5 to 25 mg, using the minimum effective dosage to achieve remission. Tapering should be individualized once remission is achieved.30

In a randomized controlled trial, Kyle and Hazleman31 found that oral prednisone 20 mg/day led to fewer flares than 10 mg/day. The study was limited by small sample size, but this dosage has been noted anecdotally to bring good symptom relief. On the other hand, Kremers et al,32 in a retrospective study, found that higher initial corticosteroid doses and faster tapering were significant predictors of future relapse."
--- Polymyalgia rheumatica: An updated review: https://www.ccjm.org/content/87/9/549

An older recommendation from 2011 has the following: "The only controlled study suggests that initial prednisone doses ≤ 10 mg is associated with high incidence of recurrences, whereas doses ≥ 20 mg are associated with considerable side effects [3]. " --- The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114801/

Have you been diagnosed with PMR or is the prednisone for another condition? Also, if the starting dose is not getting rid of the pain, I think you might want to contact your doctor and make sure they know that it's not working for you.

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Yes it is for PMR. Thanks for the info.

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@milld835

Thank you. I'm thinking I might have to cut it out as well. How many times a day do you have to drink your tea?

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When I ache, I drink the tea. Some days none, some days extra. Two cups per day generally take the aches away. Occasionally I had to return to a low dose of prednisone for persistent aches. But, I get off it ASAP. I have found no unwanted side effects of the tea. Hot Cocoa at night is also an anti-inflammatory.

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@patzmar

The amount of Prednisone that I am reading about here is so much more than I've gotten. I started at 4 a day and tapered to 2. My pain is bad. My doctor never suggested going higher. I was diagnosed in September and have had very little relief.

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My pain was in my upper legs and upper arms and shoulders started in June 2021- It hurt to move.
I was prescribed 20 mg of Prednisone- the pain started easing 4 hours after the first pill. I have gradually reduced the dosage since Mid June 2021 and as of March 2022 I am down to 1/2 mg 3 times a week.
Take the reduction very slowly

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@dudah

My pain was in my upper legs and upper arms and shoulders started in June 2021- It hurt to move.
I was prescribed 20 mg of Prednisone- the pain started easing 4 hours after the first pill. I have gradually reduced the dosage since Mid June 2021 and as of March 2022 I am down to 1/2 mg 3 times a week.
Take the reduction very slowly

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I appreciate your response. I have made an appointment to see my doctor to discuss my dosage. Having a big flare up now. Glad to find this site!

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I have been on , first Prednisone, now Hydrocortisone. I am on 25 mg. In the morning and 15 in the afternoon. The heaviness and pain of my arms, shoulders and neck is abating very slightly. I have a long way to go to get off of the Hydrocortisone as I decrease every 3 weeks. This detoxing has been brutal for me.

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@abbeyc

Wow, I am sorry to hear about what you are enduring! I agree with you that the back pain is the worst - I too had that and almost went to the hospital. How long have you had PMR? Do you think all these other issues you are having are as a result of the Prednisone, the PMR, or did you have some before? So it also sounds like people might reach 100% in the beginning with the Prednisone treatment but it may not last which is discouraging. Thank you for sharing. I hope you get this under control.

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Just seeing your reply! Thank you. The diabetes escalation and BP increase both due to prednisone. I believe the diverticulitis is also a result of prednisone...I had a sigmoid resection for severe diverticulitis (13 episodes from 2010-2013). This 2021 recurrence is the first since that operation. It occurred right at the connection made surgically. Doctors think the prednisone increased the chance of a maybe vulnerability in that place in my colon. It is almost a year now since that time. It has been a very rough year. But, I am BETTER now. Down to 3.5 mg now on Medrol from 10 for almost 9 months. Body pain/muscle pain maybe a 3 or 4 at times, but mostly maybe 1-2. I can live with that. The overwhelming fatigue is MUCH LESS. My inflammatory markers are almost normal. SED rate as late as April and May 2022 was greater than 130! I felt horrible. It is only 3 months later and I am probably at a 34 SED RATE. CRP normal now.

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I started on 15 mg, but it took 3 weeks to get pain control.....NOT pain free. Diagnosed just before my 55th birthday, in September. Now down to 12.5 mg. Doing well, but just caught covid, and pain is flaring a bit.

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@karenkel

I started on 15 mg, but it took 3 weeks to get pain control.....NOT pain free. Diagnosed just before my 55th birthday, in September. Now down to 12.5 mg. Doing well, but just caught covid, and pain is flaring a bit.

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Welcome @karenkel, So sorry you to hear PMR reared it's ugly head shortly before your birthday and now COVID joined along with the PMR. It's good that you are doing well with tapering. One of the key things that I learned was listening to my body when tapering down on the prednisone and do it slowly. It also helped me to keep a daily log to look back at when I was tapering down to the next level.

Do you keep a daily log of your pain level and your prednisone dose for that day?

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I took a single 40mg dose, sweated through the night and was pain free the next morning. My dose was reduced to 20mg, then 10mg. I am now at 3mg/day. However, I have morning pain in both wrists, which is new for me. I no longer have shoulder or hip pain. PMR seems to spin a wheel to see what part of my body it will affect on any given day.

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@robertk1952

I took a single 40mg dose, sweated through the night and was pain free the next morning. My dose was reduced to 20mg, then 10mg. I am now at 3mg/day. However, I have morning pain in both wrists, which is new for me. I no longer have shoulder or hip pain. PMR seems to spin a wheel to see what part of my body it will affect on any given day.

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Welcome @robertk1952, 40mg seems like kind of a high dosage for PMR alone. It's good that you no longer have should or hip pain. PMR can flare up if you taper to quickly. Did you discuss the new symptoms of pain in your wrists with your doctor?

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