"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