The lowest effective dose, how is it defined?

Your doctor should be happy that if you need to be pain free by going up a bit, so be it. Pain is an indicator that your adrenals aren't yet ready to take over. Is she a rheumatologist and if not, is she aware of GCA? Everyone has different thresholds of pain but the thing is, you should not be in pain, period.

Thanks for the helpful info. It gives me some hope and encouragement.

PMR is "self-limiting"--meaning, yes, at some time it sets us free. I read that the average duration of disease is 5.9 years, but apparently there are two classes of PMR and some are lighter than others. Here is a short paragraph to read: https://pubmed.ncbi.nlm.nih.gov/4036982/.

Thanks so much for the information!

Mary- This last spring, I would hsve described my pain as a 20 on a 10 point scale and was ready to cut off my arms or jump off a roof. For six to eight weeks, i have felt very good and am back to my old self. I am ecstatic that I can get in and out of the bathtub so easily as I love baths. I have recently gone to 5 mg and have had no problems titrating down. Late June my crp was down to about 10. Assume it is even lower now. The sed rate started at 20/high normal and in late June was 6. Will see what happens but I am very encouraged.

Thanks so much! I was diagnosed in April and on 20 mg
for two months. It was wonderful. I tried tapering to 17.5 but had to go back to 20 in July. Now I am trying tapering again. Your message was such good news! Today seemed to be a better day for me so eventually I hope I will be as fortunate as you. You give me hope! I love baths and would sure enjoy one.

That article is from 1985. Here's one from NHS showing 18-24 months for therapy:
https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/polymyalgia-rheumatica

This is a really helpful survey of our disease. The assertions are rather general, though, aren't they?
"Although your symptoms should improve within a few days of starting treatment, you'll probably need to continue taking a low dose of prednisolone for about two years."
It's different for all of us. It would be interesting to see a study of the different durations of disease (as opposed to prednisone therapy) and perhaps we might get closer to understanding the cause of PMR.

The start dose for PMR varies from country to country with the US most often starting at 20mg and Australia, where I am, starts at 15mg. An Italian study (2011) found that 78% of people started on 12.5mg responded well, but effectiveness depended on the weight of the person with heavier people needing to start on 15mg.
I can't yet post links. Title is "The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity".

I think I would have struggled more with the reductions above 10mg if started on a higher dose. Also, I ignored the directive to stay on 15mg for a month, knowing that in the first 2-3wks of prednisolone treatment the dose can be reduced more quickly without adverse effects. So I dropped as much as I could in those first 2-3wks (15mg down to 11.5mg) to get a head start on reductions.

Hi @megz, I can post the link for you but the problem is that it is old information (2011) and I think it's changed some --- The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity: https://pubmed.ncbi.nlm.nih.gov/21569559/.

Here is some updated information from 2023 and 2022:
--- Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica: https://ard.bmj.com/content/early/2023/02/23/ard-2022-223429
--- Polymyalgia rheumatica: An updated review: https://www.ccjm.org/content/87/9/549