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Is it PMR (and/) or Osteoarthritis?
Polymyalgia Rheumatica (PMR) | Last Active: Apr 10 2:54pm | Replies (51)Comment receiving replies
PMR diagnosed late September, started prednisone 20, had to bump to 30, started tapering -5 every two weeks, now at 9 and tapering -1 every month. SED now normal, rheumy says we are therefore finished treating PMR, and the task is to get off prednisone without triggering adrenal insufficiency or crisis. Experiencing an elevated hemoglobinA1C due to prednisone, not enough to require insulin, fortunately. Current pain/stiffness level 1 to 1.5 confined to wrists and fingers, gone by 1500 daily, diagnosed as osteoarthritis (which was evidently there but asymptomatic prior to PMR). Taking tylenol AM which helps quite a bit. Note: Apparently need to avoid NSAIDS while on prednisone due to possibly problematic interaction. Good luck to everyone on this trip.
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"rheumy says we are therefore finished treating PMR, and the task is to get off prednisone without triggering adrenal insufficiency or crisis."
Thank-you for making this point. I should have known about this in the very beginning of treatment with prednisone. Adrenal insufficiency, to some degree, is an inevitable consequence of long term prednisone use. However "long term' isn't really very long.
Tapering prednisone slowly is recommended because of the risk of adrenal insufficiency directly. The indirect risk of PMR flares is probably due to adrenal insufficiency when one considers that one of the functions of cortisol is to regulate inflammation.
When we have a low cortisol level after we get to a low dose of prednisone our body's ability to regulate inflammation is compromised. Cortisol is called the "stress hormone." It stands to reason that stress of any kind triggers inflammatory flares when our cortisol levels are too low.
It took a person who suffered an adrenal crisis to explain this to me. Something clicked so I understood why I was unable to taper off prednisone after more than 12 years. My endocrinologist thought it might be impossible for me to taper off prednisone after that long.
Tapering off prednisone can be done even after 12 years but I needed to take a biologic that didn't suppress my adrenals. I stayed on 3 mg of prednisone for 6 months until my cortisol was at a low normal level. From start to finish it took nearly a year to be able to easily taper off prednisone.
A PMR flare was still possible but that inflammation was blocked by the biologic