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Tapering prednisone
Newly diagnosed, brought on by pneumonia. First flare was swelling and pain in shoulders, arms and hands to the point I had to go to ER. Put on 50mg of prednisone there and told to follow up with primary (who is out of the country), so I ended up with PA. He is tapering, but I think too much. 50 to 40 for a week was doable, but this week is 40 to 20 and anytime I do even a short bit of activity the pain and swelling comes back, and now I have swelling in legs and feet. Thoughts??
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Sounds like a difficult diagnostic situation that is not classical for PMR. There are some forms of arthritis that occur after an infection. Further evaluation of your specific situation might be helpful.
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1 ReactionWelcome @sslions, By PA do you mean Psoriatic Arthritis (PsA)? I don't have any experience with the condition but have had PMR flare ups twice and 20 mg prednisone was the starting dose both times and took care of the pain for me. You might want to take a look at the following discussions to see if it is similar to what you have?
-- Psoriatic Arthritis: https://connect.mayoclinic.org/discussion/psoriatic-arthritis-5/
-- What are the latest treatments for Psoriatic Arthritis?: https://connect.mayoclinic.org/discussion/psoriatic-arthritis-3/
See if you can get a consultation with a rheumatologist.
I would assume you mean Physician’s Assistant and I would definitely think that cutting prednisone by 50% at a time is way out of line . Not a doctor or even a PA or medically trained but through experience, talking to rheumatologist and information from this site, dropping milligrams by that much is a recipe for disaster. I dropped my initial dose of 20mg to 15mg and had to go back up just to get some relief. Discuss this with your PA and/or get a second opinion.
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1 ReactionTry to keep your taper to not more than 20% each increment. 50 to 40 was OK….40 to 20 is 50%. The time between each taper should be up to You and your symptoms. It’s going to take some time. Your adrenals need to “ wake up” slowly. ….good luck
40 to 20 is crazy. No wonder you are hurting. No one can drop that sharply.
@johnbishop I believe in this case and context PA means Physician's Assistant.
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2 Reactions@sslions it seems to be totally different for so many people. Prednisone is horrible, but admittedly the pain was gone in literally an hour with 1st dose. Life back, back skiing, gym and able to dress myself. I had/have basic PMR started at 30MG, then down 5MG each week which seemed very fast but worked. NO pain. At 5MG now, thinking 2.5 and see what happens. Reading about everyone's experience is really helping. Maybe understanding that reactions may be different for different people and not get discouraged. For me anyway.
Does anyone have any notion, or article that indicates at which Prednisone dose the adrenal glands start waking up? Seems that when they start waking the tapering should be slower??
@rhb80 I believe tapering from high doses to a lower dose has not influence on your adrenals. Your adrenals are left sleeping until you get below 10mg dose and for me it is 5mg. The important part of tapering is to be pain free before starting the next step down. Talk with you provider about modifications to the taper plan based on your pain. If they have treated PMR patients prior to ou they will understand that every patient is different when it comes to tapering.
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1 Reaction@pmrnew
Found this link posted by someone else on this sight. Very helpful and informative!
https://connect.mayoclinic.org/comment/1564657/
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