Inflammatory arthritis and PMR are a bad combination. I took high doses of prednisone intermittently for about 20 years to treat flares of uveitis and reactive arthritis (ReA). I thought I was doing well until PMR was tacked on too. Then I took moderately high doses of prednisone daily for an additional 12 years.

I would have never been able to taper off prednisone until a biologic called Actemra (tocilizumab) was tried. After that, I was able to come off prednisone in 7 months while being monitored by an endocrinologist for adrenal insufficiency.

I think adrenal insufficiency was the main reason that I couldn't taper off prednisone after PMR was diagnosed. when I needed long term prednisone, my adrenals were suppressed. Cortisol regulates inflammation so when the adrenals are suppressed by prednisone, you run the risk of becoming prednisone dependent.

I think Actemra allowed me to reduce my prednisone dose to a low enough level so that my adrenals slowly started working again. It was wonderful to get completely off prednisone after so many years. I'm now prednisone free but I still need to take Actemra. I currently do monthly infusions and I don't take anything else between infusions.

Medicare will pay for FDA approved biologics for RA as long as they are infused. Medicare won't pay for injections because they are considered outpatient medications. Drug plans will only pay a small portion of the cost of doing injections if they pay anything at all.

I hope Orencia (abatacept) works well for you. Actemra (tocilizumab) might be another option for you. My rheumatologist says it would be impossible to adequately treat everything that I have going on. If you ask me, Actemra works very well for me.