Has anyone had to increase their prednisone dose to 50 mg per day for a flare?
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For a PMR flare, 50 mg would be a lot of prednisone. You should consult with your doctor before taking that much prednisone.
What dose of prednisone are you currently taking? Increasing your dose from 10 mg to 50 mg is one thing. Increasing from 40 mg to 50 mg is another thing.
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30 to 40 but not enough and thus 50. I’m an orthopedic surgeon
Are you prescribing prednisone to yourself? Did you diagnose yourself?
When I was first diagnosed with PMR, I ignored what my rheumatologist told me because I thought I knew everything about tapering off prednisone. I had a 15 year history of recurring uveitis along with reactive arthritis. My ophthalmologist frequently prescribed 60 mg for uveitis. My ophthalmologist would adjust my dose upward if needed until the uveitis responded. I was then allowed to taper myself off with instructions to call if I had difficulty with tapering. I could always taper off quickly in a month or two so I rarely had a need to call.
In retrospect, I didn't know anything about PMR but I thought it would respond to prednisone the same way as reactive arthritis and uveitis did … wrong! The treatment for PMR is "long term" as in years instead of months.
I got off to a bad start because I thought I knew everything. I got a "non compliant" label put on me because I kept increasing my dose. My rheumatologist started me on 20 mg but I increased it to 50 mg because it worked better than 20 mg.
My rheumatologist wanted me to find a "stable dose" of prednisone that worked to control my PMR symptoms. The stable dose I eventually found was 40 mg but my rheumatologist said it was too high a dose for PMR. My rheumatologist would have liked something less than 30 mg.
I refrain from giving medical advice due to my training as a nurse. However, I suspect something else is happening. It might be PMR and something else. In my case, it was a "full range" of things in addition to PMR according to my rheumatologist.
I had the same rheumatologist for 15 years after PMR was diagnosed. We found ways to work together. I eventually got off prednisone but it took a long time and an entirely different treatment plan.
That's a very very high dose of Prednisone for PMR. It usually responds well to much less. Are you dropping it again within a week or two?
It might have been good to mention you MD license .
Medication is only one facet of treating PMR. I can't say this often enough: Diet. Be careful what you eat and research the foods you need to keep away from. Best of luck and wishes for success. It is possible to get over this even it may not feel that way right now.
My pain is almost non existent when I follow an autoimmune protocol diet. It’s very restrictive and hard to comply with for long periods but when I “fall off the wagon” I can tell !!!
If you respond and can taper soon it would be informative to check
your IL-6 level and consider a biologic like Actemra.
MEDLINE research and your rheumatologist colleague should help you with the decisions.
I agree medication is only one facet of treating PMR. Diet is another important facet. The treatment of PMR should be multifaceted.
Whenever I asked my doctors a question about "why things happen," the inevitable response to my question was the problem was "multifactorial."
What is an "autoimmune protocol diet"?
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