Does you doctor recommend splitting?

What dose of prednisone are you on? I started at 60 mg to treat GCA and PMR, and I had very bad insomnia until I got down to 40 mg. After that I started sleeping ok. I just finished prednisone about 2 weeks ago. I always took it in one dose early in the morning with breakfast. I haven't had any pain or symptoms since starting treatment 14 months ago.

Was Actemra providing you with 24 hour pain relief? The only reason I ever spit my dose was because the pain relieving effects from Prednisone didn't always last for 24 hours. I woke up with pain in the middle of the night.

I couldn't tell how much inflammation I had when I was treating PMR. However, when I treated flares of uveitis, I could actually see the inflammation floating around inside my eye. It was like a dense white fog that was hard to see through. When the inflammation wasn't as bad the inflammation was more like dense white clouds with occasional breaks to the clouds. My ophthalmologist was impressed with the details I could see from the inside of my eye looking out. He could verify what I saw from the outside looking into my eye. I could describe floaters and details of things inside my eye. My ophthalmologist could identify what I saw based on my description of it.

My experience with uveitis allowed me to see how inflammation responded to Prednisone during a 24 hour period. The inflammation fog was heaviest in the morning but after I took prednisone the fog lifted somewhat in the afternoon so I could see better. By the time I went to bed, I was encouraged because the fog was better. After sleeping, the next morning, the fog was just as bad or worse than the previous morning.

That was when I started to split my dose. At first I took a double dose by splitting my dose in half. That worked but I didn't sleep well. That was when my doctor suggested that I take most of my dose in the morning and less at night. I experimented with the proportions and decided 2/3 of my dose in the morning and only 1/3 at night helped me to sleep better.

The more impressive thing was how the inflammation from uveitis responded. Whatever progress was made in clearing the inflammation fog during the day was sustained overnight.

It wasn't like a single prednisone dose in the morning cleared up all the inflammation during the day. It was a process over the course of many days for the fog to dissipate. The nice thing with a split dose was the progress made on one day carried forward to the next day.

I think the uveitis inflammation improved faster because I never allowed my blood level of Prednisone to drop. That wasn't so good for my adrenals but it was good for uveitis. I could go from 60 to 100 mg of prednisone and taper off in a month or two so my adrenals weren't suppressed too long.

I just wish to add that pain is never the best indication for how much prednisone to take. It took me a long time to learn this but my doctors tried to teach me this.

My ophthalmologist told me many years ago that it was fortunate that I felt some pain when my uveitis flared up. I said the pain wasn't that severe. My ophthalmologist said the bigger problem with uveitis was that some people can't feel any pain. He said the other symptoms are easy to ignore until it is too late and people end up being blind. I was just fortunate that the pain was severe enough and I could get immediate treatment.

I suspect GCA pain is the same relative to PMR pain. The prednisone dose for GCA is 60 mg without too much pain. People with PMR get 15 mg when they are debilitated and in severe pain.

The difference is where that pain is at and how much damage it can do. It is never about how much pain a person has that determines the dose of prednisone.

Prednisone isn't always the best medication to prevent damage. That is how Disease Modifying Anti Rheumatic Drugs (DMARDs) got their name. They do a better job at limiting the damage caused by RA and other autoimmune conditions.

I have Reactive Arthritis. When it flares the pain is sudden and intense. Reactive Arthritis is an autoimmune condition that might get Prednisone initially but only short term and never long term. There are better medications to prevent flares of reactive arthtitis from happening. This is because reactive arthritis flares cause damage when untreated but typically the flares don't last too long after treatment. It was hard for me to know when my pain was from an acute flare of reactive arthritis versus the chronic pain of PMR. It was just easier to take Prednisone for everything.

I was on prednisone alone for about 6 weeks, and then prednisone and Actemra together until recently. I haven't had any pain or stiffness since I started treatment 14 months ago. Mornings have never been worse than any other time.

I think Actemra controls the pain longer than prednisone. That probably explains why I can go a month between infusions.

I do think the faster remission happens… the better. Prednisone might be better for fast remission but it isn’t sustained well.

Most doctors do not recommend splitting a dose of prednisone due to sleep problems and other problems associated with doing it. Some doctors will allow it depending on the individual patient's problems. It is not suggested to remine on a split dose long term since it does not mimic your body's natural release of steroids daily. If you are waking up in pain during the night I would suggest you talk with your doctor about their preferred solution. Everyone' s PMR journey is different, and every doctor is different. Unfortunately, there is no single correct answer to your question.

I am on 25 mg of prednisone and it was not lasting the 24 hours. By 4am the inflammation would start creeping back in. My next dose wasn’t due till 7am. And by the time that dose started to reduce the inflammation it was almost noon. I decided on my own to split dose. 3 pills at 7am and the other 2 between noon and 2pm. It worked like a charm. I am going down to 20mg on 1 September (2 in the am, 2 in the early pm). My rheumatologist is fully supportive of this dose splitting. I take them late enough to buy me extra hours in the morning but early enough not to disrupt my sleep at night.