I started taking 15 mg of pred in October and reduced to about 2. I've now come to terms with the disappointment and realise I probably reduced too quickly. I am now back up to 5 mg but still have some aches. I was wondering if it was better to keep increasing the steroids again until the pains are no longer there and then reduce again or to up the steroids a bit to a manageable level and then stick.
Posted 10 years ago. However there is a myriad of information about steroids and reduction. As you will be aware, steroids are not the cure, there is none and no known cause either. Steroids are there to enable you to live your life as near as possible to what it was before, it will never be the same and it is a question of finding where you are most comfortable at.
We are all different. If you visit www. Quite a few people have used this successfully. The main trick is to go down slowly, perhaps just my 1mg. Decide a day you are going to take the drop, say a Sunday and then go for it, wait abou 5 or 6 days and if the discomfort goes away, that probably means it was withdrawal symptoms, but if the discomfort does not go away, that is the pmr and go back to where you were.
If that does not give relief, you may have to up it and start all over again. My Rheumy advises that when you reach 5mg, you stay there for three months, then take a 1 mg drop and repeat the three month timetable. And 5mg is classed as a low dose. It is harder to make the drop when you are on a low dose, as the percentage of the drop increases and this is why people experience difficulty.
And please remember do not suffer unnecessarily, steroids are not the enemy, the PMR is. Welcome to our exclusive club that we don't really want to be members of! You will find loads of information relevant to your question in threads that have been running so do try and find time to read at least some. There is a lot to take in and sometimes there is stuff in the middle of a thread that is relevant so it can take a while to find it.
I'll try to summarise the main bits:. I started on 15mg per day last August and am currently taking I got down to 7. It wasn't steroid withdrawal, it started after a few days and got steadily worse over the next couple of weeks until I gave up and went back up. So at the beginning of March I tried something else - I changed to taking double the dose but on alternate days.
This is a recognised way of using steroids in other diseases needing longterm steroids and reduces the incidence of side-effects. There is a thread about this somewhere. I changed over a few days to taking 15mg every other day and then have tried reducing the dose again. I got down to I had also fallen and bashed my knee and the two together caused a flare in the PMR which is why I'm back up to I've told you this as a comment on your query about going back up.
One explains steroids and the other is about when to take them. Between them they'll tell you loads about how they work in PMR. There is no cure for PMR so you are using the steroids to reduce the inflammation that is the cause of the pain so you can move and have a life. If the dose is not high enough, the inflammation gets the upper hand and the pain and stiffness return. It is unlikely you will be totally pain free and the steroids only have a partial effect on the fatigue aspect of the PMR.
The trick is to find the lowest steroid dose that gives you an acceptable quality of life whist avoiding the worst of the side-effects. At 17mg every 2 days I still felt quite rough, my legs were heavy and stairs difficult whereas at I went up 0. Now I will wait a week or so and then start trying to go down again. However, the list of incomplete or absent information is long.
In particular we do not know:. Which is the best initial GC dose: If we can predict it in the individual patient by gender, BMI, disease characteristics, etc. The optimal glucocorticoid starting dosage is not defined yet, and varies widely across different studies, being comprised between 7 mg and 25 mg prednisone. Some studies suggest that female gender and high ESR are indicators of the need of a higher initial dose, but these results have been not confirmed. A multicentre Italian study has been designed to compare two doses of prednisone, 20 mg and If all GCs are the same: Prednisone, prednisolone, and methylprednisolone have been not directly compared for their efficacy in PMR.
In spite of the initial promises, deflazacort seems not to have any advantage in terms of side effects, in particular osteoporosis, although its efficacy is similar to that of traditional GC. How to taper GC : The intuitive reasoning behind rapid tapering is to reduce possible GC-related side effects. However, disease flares occur more frequently when a rapid dose reduction is used, although spontaneous disease flares can occur independently of GC dose.
Shorter tapering schedules have been proposed, which permit to reduce prednisone from The baseline risk profile mentioned above should be taken into account when the tapering regimen is tailored. The main question is if rapid tapering, apart from the obvious disadvantage to the patient due to the increased number of relapses, corresponds to a lower cumulative dosage or not.
Duration of treatment: In one descriptive study, the initial dose was linked to treatment duration and cumulative dosage, for low initial doses were associated with low subsequent maintenance doses. PMR is probably more chronic than previously thought, with relapses occurring also years after successful treatment and GC interruption. However, it is not known if a longer treatment period is associated with less relapses at long-term follow-up.
In view of the high incidence of GC-related side effects, which are associated with GC cumulative dosage, an attempt should be made to shorten as much as possible the course. If there are effective alternative administration methods of GC: Intramuscular depot methyl prednisolone is effective in reducing the cumulative GC dosage and the incidence of vertebral fractures. In spite of this proved advantage, this route of administration has been not widely used.
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Cimmino , Marco A. E-mail: cimmino unige. Oxford Academic. Google Scholar. Dario Camellino.