How does one know when it is OK to start a slow taper?

@christi48, How long have you been at 5 mg? How big of drop did you do for the previous taper? If you have setup any sort of timeline like trying to taper monthly or every two weeks and it's close to when you think it's time to taper, I would certainly give it a try by going down to 4 mg or 4.5 mg to see how you feel for a couple of days. I think it might also help if you are keeping a daily log of your dose and pain levels.

Agree with John above.

How does your rheumy feel about your reducing? I had a very puzzling reaction from mine the last time I reduced. He told me to "Never reduce unles he told me to. That's too fast!" Of course, the last time I saw him he wanted me down to that level and I argued that the drop was too much. We compromised on an in-between level. That went well and I went ahead and dropped to what I thought was the target. Apparently, I got it wrong. Or he's gone senile on me, that's possible too.

I started on 5 mg last July. Tried my first ds taper starting mid-November. I slowly decreased 1/2 mg and finally reached seven straight days of 4 in February, but at that point the pain and stiffness gradually got worse until I went back to 5 mg on Feb. 19. I'm thinking I might have made a mistake and should have used 5 for my old dose and 4 1/2 for my new dose with a target of 4 1/2 at the end of the taper sequence. Back on 5 I have good days (and nights) and not-so-good. Pain and stiffness not terrible but a nuisance. So, when should I try another taper, and should I just make my goal minus 1/2 mg. at the end of the taper sequence?

Don't see a rheumy as the ones in my area are not well-thought-of. My GP is great - listens and works with me. I see him on Tuesday as a follow-up to how I did on that taper I discussed with him. However, this forum is more educated about PMR than he is, so advice here is valuable and appreciated. Thanks for your reply.

@christi48, If I'm reading correctly, you started at 5 mg prednisone when you were first diagnosed with PMR. I'm not a doctor but that sounds like a really low starting dose. Most starting doses for PMR are 12.5 to 20 mg and it's normally based on your body weight. Folks that weigh less take less or something like that. Here's some info on the topic but it's a little old from 2011.
-- 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/.

Also there are a lot of conditions that mimic PMR.
-- Diseases that mimic polymyalgia rheumatica (PMR):
https://www.medicalnewstoday.com/articles/diseases-that-mimic-polymyalgia-rheumatica.
You might want to talk with your GP since you mentioned you don't have a rheumatologist that you trust.

@christi48

When was PMR diagnosed? @johnbishop is correct, 5 mg isn't the standard starting dose that doctors usually use for PMR.

It sounds like you are doing the dead slow nearly stop (DSNS) method of tapering. If you think that works for you ... stay with it IF your doctor agrees you should taper that way.

It sounds like you were on 5 mg last July 2022.

You tried the DSNS tapering method in mid-November 2022 and got down to 4 mg in February 2023. Now it sounds like you are back on 5 mg which was the same dose as you were taking last July 2022 ...

Is that right????

If that is all correct, I would just tell your GP you are still on the same dose (5 mg) so you don't confuse your GP.

Your GP probably has no idea what the DSNS method of tapering is. There is no medical research that has been done on this tapering method. I would guess most doctors have never heard of it.

Could you please explain the DSNS tapering method. Thank you

Dead slow and nearly stop reduction plan (DSNS - Tapering)
https://healthunlocked.com/pmrgcauk/posts/131189593/dead-slow-and-nearly-stop-reduction-plan

I’ve reduced my prednisone from 15 mg to 6 mg but it has taken me a year. I’m now going to try this method by reducing 1/2mg at a time. Thank you for the wonderful explanation.
Stephanie