Prednisone taper: Apparently < 4mg no longer controls inflammation

Posted by casinokid1121 @casinokid1121, Aug 2 1:30pm

Any thoughts on this. I had my 6 month check up with my PCP and was discussing my PMR. I am being treated by a rheumatologist and down to 2 1/4 or prednisone, down from 30. My PCP said anything under really 4mg does nothing to control the inflamation. It just weaning down from the higher doses is what's important. Any thoughts on this. Thanks.

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

Mike | @dadcue | Aug 2 2:47pm

Basically ... I was told the same thing by an endocrinologist who said 3 mg was a small dose. My endocrinologist said there was no need to taper from 3 mg to zero and prednisone could simply be stopped. I was shocked!

Stopping prednisone in the above situation was contingent on 2 things:

1) PMR was no longer active. --- I was doing Actemra injections at the time. Actemra was working well for PMR. My endocrinologist consulted my rheumatologist to make sure I didn't need prednisone anymore to treat PMR.

2) My cortisol level was adequate. --- I had to stay on a 3 mg "maintenance dose" of prednisone for 6 months because my cortisol level was too low to abruptly stop prednisone. In essence, I was taking 3 mg of prednisone for adrenal insufficiency while I waited for my adrenals to produce more cortisol.

My adrenal function recovered while I maintained a low prednisone dose defined as 3 mg or less by my endocrinologist.

Only after my cortisol level increased was it safe to discontinue prednisone. My endocrinologist said I didn't need to taper from 3 mg to zero as long as PMR was controlled AND my cortisol level was adequate. I was told a taper wasn't necessary but I did a fast taper anyway.

My symptoms of adrenal insufficiency improved after I discontinued prednisone. However, my endocrinologist said I should restart 3 mg of prednisone for any reason if I felt the need.

John, Volunteer Mentor | @johnbishop | Aug 3 4:20pm

Hello @casinokid1121, You will notice we changed the title of your discussion a little to better reflect what the discussion is about. Also thought I would share a link to your previous discussion so that other members can read your original discussion and how you got to this point -- Polymyalgia rheumatica: Any thoughts on my taper plan?: https://connect.mayoclinic.org/discussion/polymyalgia-rheumatic/.