Does prednisone do more than treat the symptoms of PMR

Posted by christopherc @christopherc, Feb 25, 2023

I’ve had PMR for over two years now. I was on prednisone from March 2021, until March 2022 and felt pretty good while taking it. After going off it I’ve had significant bouts of muscle pain and stiffness not just in the morning. It seems like the inflammation accumulates over time and gets worse. I’ve gone on 400 mg of Celebrex per day, which has helped some but not alleviated the symptoms all that much. I also get an overwhelming feeling of fatigue every day around noon and have to take a nap for about 40 minutes to alleviate it. I also get easily tired if I do anything strenuous.

My former rheumatologist wanted me off the prednisone on a pretty aggressive schedule, pairing from 15 MGMs to zero in one year. She seemed to think that the side effects of prednisone were bad enough that you should tolerate some pain and stiffness to get off it.

I’m seeing a new rheumatologist the middle of next month and I am considering asking her to put me back on prednisone because nothing else I’ve tried seems to work.

My question is: does anybody or their rheumatologist think that prednisone actually causes PMR to go into remission by turning off the autoimmune function causing the inflammation and stiffness or does it just treat the symptoms?

I am thankful for this support group and any insights anyone would be willing to share about this. Thanks.

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

John, Volunteer Mentor | @johnbishop | Feb 25, 2023

Hi @christopherc, I do think the prednisone plays a large part of causing PMR to go into remission by treating the root causes, inflammation for one. This article is from the US Pharmacist's website has a chart under the treatment section that lists why prednisone is the drug of choice for treatment along with some great information on why there is a controversy on the dose and duration of treatment.
--- Polymyalgia Rheumatica: A Severe, Self-Limiting Disease:
https://www.uspharmacist.com/article/polymyalgia-rheumatica-a-severe-self-limiting-disease.
You might also find the following discussion helpful:
--- PMR - How will I know I am in remission?: https://connect.mayoclinic.org/discussion/pmr-8/.

I was started on 20 mg prednisone dosage for both of my occurrences of PMR. The first time was the worse for me because I didn't know what to expect. It took me 3 and half years to taper off. The second time around six years later was much better and only took me 1 and half years to taper off. I'm happy to hear you have found a new rheumatologist that will work with you on the treatment.

christopherc | @christopherc | Feb 25, 2023

Thanks so much, John.

I will read these articles and I am encouraged by what you’ve said. Maybe it makes sense for me to go back on prednisone at least at some low dosage for some period of time to push me into remission. We’ll see what my new rheumatologist says next month and I will be sure to post an update.

Thanks again for all the work you do for this group. It’s much appreciated.

DadCue | @dadcue | Feb 25, 2023

In reply to @johnbishop "Hi @christopherc, I do think the prednisone plays a large part of causing PMR to go..." + (show)

Sorry, I meant to reply to @christopherc

I have a bit of experience treating other autoimmune disorders with prednisone. Those autoimmune disorders were "steroid responsive" because I was able to take 60 mg and get back to 0 mg in a month or two. High dose prednisone followed by a fast taper worked well for inducing remission of those conditions.

PMR was something new to me when it was diagnosed. I took 40 mg to control my symptoms but my rheumatologist didn't want me to taper off quickly. I wasn't able to taper off quickly so it that didn't matter.

After 12 years, I was still taking taking 10 mg and still couldn't taper off. I experienced the overwhelming fatigue and had many medical complications during the 12 years I took prednisone. There was nothing benign about taking prednisone for a long time.

I would say that prednisone does a lot more than just treat the symptoms of PMR. Most of the things prednisone does aren't good which is why doctors want you to taper off as quickly as you can.

Prednisone has a profound effect on your immune system and not just the autoimmune part of it. I also makes it so your adrenals don't function well and it disrupts the HPA axis.

The following is worth reading:
https://connectedrheumatology.com/do-you-need-prednisone/

christopherc | @christopherc | Feb 25, 2023

Thanks for this thoughtful response and your insights. They will be helpful to me in talking to my rheumatologist. I think much of what you said about the negative affects of prednisone is why my original rheumatologist wanted me off at as soon as possible. However, as in your case, it seems it takes longer sometimes to get the patient to where he can tolerate not being on prednisone.

Thanks again.