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Are There Guidelines for Prednisone Tapers
I am new to PMR: Diagnosed 1 month ago. I really want to learn more about reasoning, professional opinions, and guidelines to prednisone tapers schedules. I am taking a high level, tapering down every 2 weeks it seems excessive. How can you evaluate this? My sed rate is now down to a normal level
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@petermccarville
EULAR released newer recommendations in 2025 but nothing that is too earthshaking.
https://ard.eular.org/action/showPdf
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I don't know why there doesn't seem to be any collaboration with the ACR. In part, it might be more widespread use of IL-6 inhibitors and other biologics in the USA.
Pure speculation on my part.
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2 Reactions@petermccarville Is there a diagram of the hip, back and thighs on this YouTube as well?
@boo3 Same advice from my Rheumy. I split my dose 2 times a day. Just read advice not to on this site. What is your experience?
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1 Reaction@eparnold0219
The first video at the start of this discussion mentions "split dose' at the 4 minute mark of the video. It is not recommended unless patients have significant pain at night.
I split my dose and was able to sleep all night without pain. It is sometimes called B-I-D dosing in the video. When I stopped having pain at night -- I stopped splitting my dose. I didn't split my dose for the whole duration of my treament of PMR. When I spit my dose. it was amazing how well it worked to relieve the night time pain I had. I usually did 2/3 of my dose in the morning and 1/3 of my dose in the evening. It shouldn't be a 50/50 split. The bigger portion should be in the morning. As usual ... discuss this with your doctor.
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3 Reactions@dadcue . Thanks for the update on literature.
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2 Reactions@pah17 I believe they have MRI or other scan photos on the video I posted yesterday. They show inflammation in the hips, shoulders, back bursas. I was also interested to learn that the primary inflammation is in the insertions (connections) between the tendons and muscles with bursas having secondary inflammation. For me, the bursas in my shoulders were the first to appear painful. The other areas followed. I had quite a classic presentation of symptoms and blood work.
@petermccarville thank you for sharing this video. I am struggling with the addition of Kevzara I just took my 2nd injection 3 days ago and I am aching like I have the flu. Hips, mostly but my joints in general. I also am taking Methotrexate, 17.5 mg once a week. And on 8 mg of prednisolone. My fractured sacrum is the cause of my Rheumatologist adding these drugs to try to reduce my dependence on that, I have osteopenia.
I see the improvement start to show once on the Kevzara for a few weeks.
Early days.
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1 Reaction@dadcue Transitioning to one dose sounds like an art form. I will contact my Rheumy. Thanks!
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1 Reaction@eparnold0219
I split my dose when I took higher doses of 15 mg and above. I figured that much prednisone would suppress my HPA axis no matter how I took it. When I managed to get to lower doses under 10 mg, I took my entire dose in the morning. Overall ... I needed less prednisone and had 24 hour pain relief when I split my dose.
My cumulative dose over 12 years of being treated with prednisone was still massive. It took a long time for my adrenals to recover after I finally tapered off prednisone. I would have never been able to taper off prednisone without the assistance of a biologic.
After Actemra (tocilizumab) was started, I was able to taper prednisone down to 3 mg with relative ease. I didn't think I needed prednisone anymore but an endocrinologist said I shouldn't taper my prednisone dose any lower than 3 mg because my cortisol level was too low. I didn't have too much pain on 3 mg but I felt awful and the fatigue was overwhelming.
@dadcue I will send this research to my doctor. Thank you!
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