Thanks, John. Your comments are always so clear and helpful. I do understand what happens when the taper reaches a low number--different, I guess, for different people--but at the higher levels (I am at 17.5) the taper seems to work, too, and I believe my adrenals are still fast asleep. I am fascinated by this stuff and recognize there is still so much we don't know.

I had a condition that was was called “prednisone responsive” but only if I took a high dose. I usually started with 60 mg followed by a fast taper over a month or two. I could only tolerate 60 mg for about a week so it was good that I could taper down quickly.

When PMR was diagnosed my symptoms didn’t respond well to the higher dose but my symptoms were “manageable” at 30 mg or so. That was my “stable starting dose” however inflammation was still present on 30 mg.

It took many years to get down to 10 mg and maintain that dose. By that time my adrenals were very suppressed and my cortisol level was low unless I took prednisone.

I think my adrenals were incapable of regulating any increased levels of inflammation whether it was caused by PMR or something else like an infection, or other forms of stress … emotional or physical. It all caused inflammatoy pain. Whether or not it was PMR was hard to know with any certainty.

I think it mostly depends on how quickly a person can taper off prednisone. That becomes harder and harder as time goes on because the body because dependent on the exogenous kind of cortisol.