PCP advising fast taper

That taper seems unnecessarily fast. I'm tapering prednisone, and I also take weekly Actemra injections. The Actemra controls the inflammation from my GCA and PMR. Once I got down to 5 mg per day of prednisone, my rheumatologist recommended tapering 1 mg per month. He said it would take that long for my body to adjust to each new level without causing adrenal issues. I assume you're not taking a biologic drug like Actemra or Kevzara? If you're not, it is more likely you would flare when you're tapering. Most people who are not taking a biologic drug taper .5 mg a month when they get down to 5.

I agree with @jeff97 that it does seem a little to fast, especially if you have back to have more pain. My Mayo rheumatologist worked with me on my tapering schedule and let me use my level of pain in the morning as a guide as whether to taper to the next lower dose or not. My first time around with PMR was 3 and half years and the last six months was going back and forth between 1 mg and 1/2 mg prednisone until I could finally stop taking it and my pain in the morning was less than 2 on my pain scale and generally went away once I started moving around a little. I like the information in this discussion started by @dadcue who might also have some thoughts for you:
-- How to Slowly and Safely Taper Off Prednisone but ... no set rules.
https://connect.mayoclinic.org/discussion/how-to-slowly-and-safely-taper-off-prednisone-but-no-set-rules/

Hi Jeff,
It’s been a while since I’ve been here. PMR diagnosis in about 2016. Still on prednisone but down to 5mg, then 4mg starting tomorrow. This has been multiple years of decreasing then up then back down. Rheumatologist insists it’s osteoporosis or fibromyalgia as I can’t have PMR with a sed rate..highest 36 and CRP always normal. This is the third doctor at this office. GCA was a concern, jaw locking and terrible headache about 6 months ago. My teeth still hurt, jaw is better and headaches come and go but nothing like the scary one. Surgeon won’t do a temporal biopsy since I’ve been on prednisone so long. My pain these days is so debilitating in the mornings, improves by evening. Kevzara caused chest pain and chest rash, Actemra took my sed rate to ZERO. Methotrexate caused nodules in wrists plus a 13 mm lung nodule which was not present 2024. That was an incidental finding as I passed more kidney stones in February 2025. Hand pain is retuning so one of the biologicals probably helped but now, won’t take them. Palindromic PMR (arthritis?) is what I was told can happen to hands and feet. This information was from my previous rheumatologist who stopped her practice, then opened her own office and mentioned my insurance didn’t pay her enough! Sorry I haven’t been more involved here but it’s been challenging the last year. I know my body and look forward to any comments/replies.
Karo actually Carol

Carol, I'm sorry you've had PMR for so long. I've read several times that ESR and SED rate can be normal and the person still have PMR symptoms. You would think most rheumatologists would know that.

People on this forum frequently mention that they split their prednisone dose into a morning dose and another dose later in the day, and that helps lessen the pain they have first thing in the morning. For example, if you're taking 4 mg per day, you could take 3 in the morning and 1 later in the day. If you do a search on "splitting dose" there are a lot of matches.

Hi Jeff, I will look into that. My previous rheumatologist said never split dose. Certainly a lot of professional opinions. I do want to stop prednisone because of the side effects. Adrenals are probably not working . Didn’t realize there can be pain from that too. Las Vegas has very limited doctors, especially specialists. It was suggested I go back to UCLA but traveling right now is not an option for me because of the physical limitations.
Thank you for your reply.
Karo

Thanks @jeff97 I am not taking any biological. I also think the taper schedule was too fast but I didn’t question my doctor at the time, hoping it might work. This makes me doubt she has much experience with PMR

Thank John @johnbishop I was so hopeful the fast taper would work, I didn’t question my PCP. Learned my lesson! I will check out the other discussion

Reducing ~10%/month worked for me. I have been off prednisone for several months now. Still feel a little discomfort in the morning, yet bearable. Good luck!

"Actemra took my sed rate to ZERO."
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A zero Sed Rate is within the normal range and it isn't a bad thing. I do monthly Actemra infusions and my CRP and ESR are now negligible. Prior to Actemra my inflammation markers were always higher than normal range.

I was shocked to see my inflammations marker so low and I asked my rheumatologist if they were too low. Very low inflammation markers are now my new normal. My pain level is well within my tolerance too.

I was on Prednisone for 12 years for PMR. I never could get much lower 10 mg. When Actemra was started, I rapidly tapered to 3 mg. I had to stay on 3 mg as a "maintenance dose" because of adrenal insufficiency. My symptoms of adewnal insufficiency were generalized aches and pains but not as severe as PMR pain. I also had extreme fatigue and frequent dizzy spells until my cortisol level improved. I had to stay on 3 mg of Prednisone for 6 months until my cortisol level was adequate according to an endocrinologist. My symptoms of adrenal insufficiency improved the most after I discontinued Prednisone.

Whether the taper is fast or not depends on many factors. What was your highest prednisone dose and what was the duration of time you were taking prednisone?

Normal inflammation markers are what you should expect when you are taking Prednisone. That doesn't necessarily mean PMR goes away and it can "flare up" again when your Prednisone dose is lowered or when you stop prednisone.

Depending on how long you stayed on 3 mg of Prednisone, that might be a low enough dose for some adrenal recovery. Your adrenals were likely producing some cortisol or you wouldn't be able to taper to zero and stay on zero for 4 days until your aches/stiffness returned. These symptoms don't always mean that PMR has returned and these symptoms can easily be caused by something else.

Since you are on 0 mg of prednisone that is the best time to see what your inflammation markers are doing. Work with your doctor and tell them about your symptoms. Maybe you should ask if your inflammation markers need to be checked before going back on Prednisone.

Checking a cortisol level after you have been off Prednisone for 4 days would also be a good idea. This might depend on how long you were on Prednisone.