what to expect when starting prednisone for PMR

Hello @tonimcbride, Welcome to Connect. My first time with PMR I also had lived with the pain and stiffness for awhile until it got so bad I couldn't walk and had to use a wheelchair for my appointment with the rheumatologist. I had an appointment in the morning and they drained some fluid from my right knee and I was diagnosed with PMR and given a prescription for 20 mg prednisone. We filled the prescription at the Mayo pharmacy at noon and I took my first dose at lunch. We waited for a couple of hours for a follow up appointment with the rheumatologist that afternoon. I was amazed that I was able to walk out of the appointment pretty much pain free. After that I pretty much had some mild pain and stiffness when I got up in the morning and took my dose of prednisone which would go away within an hour or so. The rheumatologist suggested I keep a daily log of my level of pain when I got up and my dose for the day so that I could use the log to help with my tapering schedule.

I have had 2 PMR flareups with the first one lasting 3-1/2 years and the second one lasting 1-1/2 years. I think movement and stretching of some sort really helps whether it's gardening, walking or exercise. I just had to learn how much I could handle without giving myself more pain the next morning. @dadcue has started some great discussions for learning more about PMR and what helps. Here are just a few that I think you might find helpful:
-- History of PMR -- Interesting video presentation from past to present.
https://connect.mayoclinic.org/discussion/history-of-pmr-interesting-video-presentation-from-past-to-present/
-- Prednisone love/hate support group: https://connect.mayoclinic.org/discussion/prednisone-lovehate-support-group/
-- Comprehensive Overview Of PMR: https://connect.mayoclinic.org/discussion/comprehensive-overview-of-pmr/

How is your PMR pain in the morning if your activity during the previous day was light?

I was fortunate to respond with most symptoms relieved
within a week on 20 mg.
Consider proactive measures to avoid side effects of likely continued use of steroids. Move to your tolerance with exercise. Mediterranean diet may help to maintain
BP and metabolism. Monitor glucose and blood pressure
at home. Consider a Dexascan baseline check.
Not all physicians are aware of the cardiovascular risk
with systemic inflammation. Reevaluate your cardiac risk profile and ask if you need statins. Know your numbers and test results. You will have good support
information on Connect.

Hi John, thanks for your reply. If activity the previous day was light, the pain is pretty minimal. If I pushed it the day before I will have more stiffness and pain. I also have a lot of fascial pain: behind the knees, in my right forearm, so the doctor suspects I may have something else going on in addition to the PMR.

Hello @tonimcbride
I got immediate, total relief in about three hours after starting 20mg Prednisone. I was at the point of needing help to get out of bed because of the pain in my shoulders. Hips were stiffening and painful. Flexibility always improved with less pain after a hot shower. I had gradually worsening symptoms for a couple of months before I checked in with my doctor. I'm now @ two years and 5 months only now I'm pretty sure that I might be going into remission? Not positive. I'm down to 1.5mg tapering by .5mg every two months.(Had one flare up in my first 6 months that backed up the tapering progress). At 1 month intervals I experienced more intense withdrawal symptoms from the Prednisone in the first 3 weeks of the taper. Also more of my diverticulitis. After the first year and a half my reserve energy and exertion levels began to slowly improve. I'd say I'm at around 75% of my original reserves. But I also have to factor in age related changes. I'm 73 now. Had a terrible time last month with my L4 L5 bulging disc that hadn't acted up at all until I got down to 2mg. So for about 7 months or so I've not noticed the classic PMR symptoms during each drop in Prednisone. Wishing you the best. Lots of helpful information here at Connect.
Ernie

Thank you! People's feedback is very helpful.

I started on 20 mg/day of prednisone 15 days ago taking it early in the morning. After six days I still had morning pain in back and shoulders that was pretty severe but it cleared up after 3 to 4 hours and I was fully functional. My Rheumatologist approved increasing the dosage to 25 mg/day in two 2.5 mg/day increases. So I increased to 22.5 mg/day but it did not help as much as I expected. I still had the morning soreness. Instead of increasing the daily dose further I changed to taking 5mg at 7pm and 17.5mg at 6am. My morning pain went away. I'm much more energetic on my morning walks. I don't have any noticeable insomnia (potential side effect). That was six days ago. This was my first encounter with PMR or any other rheumatoid related condition. I'm 73.

Interesting. I hadn’t thought of splitting the dose up, but may try it. Thank you for sharing your experience. It’s such a bizarre thing to drop in on you out of the blue. I’m 63 and have no other rheumatoid conditions.

I was first diagnosed at about 45. The symptoms were straight out of a textbook that I never read. Pain was across the shoulder and hip girdle for no reason, with fatigue. Without doing any lab work, the rheumatologist prescribed 10 mg prednisone, and within 6 hours, I was a new man. The change was so obvious that my wife noticed it before I told her what I did. That was 40 years ago, and I have been on and off prednisone for all that time, mostly on. I have seen 5 rheumatologists during the 35 years of treatment with different treatments and diagnoses. Currently on Kevzara and down to 2.5 mg of prednisone. I also take Tylenol for pain.

The prednisone fixed me up in a day or two but it was, what Ives learned, a seemingly very high dose. Below is my story . I’m a 59 year old man.

I started having bilateral shoulder pain and hip pain in mid May this year (2025). I thought I’d overdone my workouts and pickleball but the pain kept getting worse. Even taking time off.

A few weeks later I went to the primary care Dr who gave me a steroid dose pack . That made the pain go away completely. I restarted exercise and two days after the dose pack was completed, the pain started again. I was doing PT, with lots of dry needling I had to go out of the country and on business trips so missed seeing the Dr for about a month. On July 19, the Dr told me she thought I had PMR and started me on 40 mg/day for 5 days, then 30mg, then 20, then 10 mg. That seeming very large dose made me high as a kite, so I tapered every 3 days instead of five days. I also tapered by 5 mg instead of by 10 mg. Couldn’t get the drai I did what I thought it seemed reasonable. Today was the third day at 15 mg. I’ll try 10 for three days and go from there with hopes of being at 5 mg by Wednesday when I see the rheumatologist.

I also stated the Whole 30 diet (tons of veggies and meat. No grains, sugar, dairy or alcohol. Also cut out all nightshades ( tomatoes, egg plant, peppers) dwell as eggs and nuts.

My hope is to see the rheumatologist and have diet have fixed stuff…. A bit of positive thinking.

Soar 15 mg, I am good until about 8:30 and I am then very tired.

I spit the dose (10 in am and 10 in pm). No pain in morning or night.

Then I read one of these posts and realized the prednisone could be causing my lack of sleep. Yesterday I went to 15 total and took all in the morning. Last night was first real sleep since mid June.