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The lowest effective dose, how is it defined?

Polymyalgia Rheumatica (PMR) | Last Active: Oct 28, 2023 | Replies (56)
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@johnbishop

Hi @megz, I agree with @pkalkstein. The lowest effect dose is a rolling target and has more to do with your pain level than the amount of time you spend on prednisone. If you don't take enough, the pain will not be addressed and I suppose if you overdo it the pain will also be addressed. I think that is specifically why my rheumatologist urged me to keep a daily log with my level of pain when waking up and the amount of prednisone I was taking for that day. I believe the average starting dose is 12.5 mg to 25 mg. For both of my occurrences of PMR, I started at 20 mg and was pain free within a few hours of taking the first dose and stayed that way until the morning.

You might find this research helpful:
--- 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative: https://ard.bmj.com/content/74/10/1799

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Replies to "Hi @megz, I agree with @pkalkstein. The lowest effect dose is a rolling target and has..."
megz | @megz | Aug 7, 2023

Yes John, I record brief notes on the calendar daily and use it at doctor's appointments, currently every month. I don't use a numbered pain level but use words like "pain tolerable", "aches only", "stiff but no pain", "no pain at all".

I have been entirely focused on getting off the 'roids as quickly as possible, but now am more aware that the disease has to run its course, so there must be time allowed for that too. Re-emerging pain is a good educator. I hear medical people say the 4-8wks for each taper is to let the adrenal glands "wake up" with hardly a mention of the importance of giving the disease time to run its course.

I'll have a good read of that paper, thank you.

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