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← Return to Tapering off of Prednisone
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Hi! I'm new to this group as I was diagnosed with PMR in December 2022. I am 62, very healthy, and generally very active and enjoy walking/hiking/biking/skiing etc. In November 2022 I woke up with pain in my upper quads/tendons which then spread to pain in my hips, shoulders and neck. I couldn't lift my legs out of bed, or lower myself onto the toilet without support. I felt like I aged 30 years overnight! Started on 20mg/day of prednisone, first for only 2 weeks followed by tapering to 10mg. Symptoms started returning so I went back to 20mg for a month. Symptoms returned again when I tapered to 10mg. Rheumatologist has not suggested tapering more slowly, instead he recommends adding in Methotrexate (which I don't particularly care for the side effects), or biologics in addition to the prednisone. He has not mentioned a different, slower tapering protocol. Is it common for symptoms to return when going immediately from 20mg to 10mg? He doesn't seem to think so, but I'm guessing there are many of you out there with a different opinion? Thanks in advance for your help.
Replies to "Hi! I'm new to this group as I was diagnosed with PMR in December 2022. I..."
Hi, lestep. In my. opinion (not a physician), going from 20 to 10 mg is not a taper. I was initially at 15 mg, and after about 6 months was told to start tapering, first to 12.5 for several weeks, then 10. I hit a wall at 7.5 mg, and had to go back up a bit. Then I started tapering by 1 mg every four weeks, and also started taking Methotrexate. Right now I am juggling between 4 and 3, and my next taper will be to 2.5. We're all different, and you will probably get information from other posters, but a taper tends to be slow with smaller increments. Good luck to you.
Hello @lestep, I would like to add my welcome to Connect along with @tillysam and others. Tapering off prednisone while managing your PMR symptoms can be difficult since there is no one solution that fits all. My rheumatologist told me that I needed to listen or pay attention to my body when it comes to tapering off of prednisone and to go very slowly when needed. He had me keep a daily log with my level of pain when I first got up along with the dose of prednisone for that day. A drop from 20 mg to 10 mg sounds like too big too soon but each of us are different. Here's some information on the topic that might help you discuss tapering slowly with your rheumatologist.
"How do you taper prednisone for PMR?
Tapering once remission is achieved (following initial and relapse therapies): Taper daily oral prednisone by 1 mg every 4 weeks (or by 1.25 mg decrements using schedules such as 10/7.5 mg alternate days, etc.) until discontinuation given that remission is maintained."
--- 2015 PMR guidelines.pdf - American College of Rheumatology:
https://www.rheumatology.org/Portals/0/Files/2015%20PMR%20guidelines.pdf
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Healthunlocked.com has a couple of tapering plans which are excellent. My best to you.