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Question Regarding Initial Dose Prednisone for PMR

Posted , 10 users are following.

gilman
gilman

Hello Everyone and thanks for all your openness and sharing of information.  There is something special connecting to people who know and understand first hand PMR and the associated issues with its treatment.

 My GP referred me to an orthopedist when I complained of shoulder pain in one arm.  I couldn't raise it above my head and it had persisted for almost two months.  I had some less severe pain in my other shoulder and behind both knees.  The orthopedist took X-rays and did an MRI and saw no tear in the rotator cuff as I believe he suspected.  Physical Therapy was ordered and I complied, feeling tortured by the mild excercises I was asked to do.  

I know I am aging, 66 male, but had been quite flexible and limber until the onset of the shoulder pain.

Because I am a hobbies the potter, my shoulder soreness was attributed to working on my potter's wheel and sitting on my stool must have been the cause of the pain behind my knees.  When I told them I have been potting for over 20 years, so "why now?" They said repetitive use.  I was given high doses of Ibuprofen and when that didn't help a steroidal injection in my shoulder.  That did help and even the other pains cleared up, for a week, then it all came back.

On a subsequent visit to my GP for my annual physical, he listened to my complaints and wanted to rule out connective tissue disorders and did blood work.  Results showed ANA negative and Rhuemetoid factor normal.  My ESR was above normal and he mentioned PMR as a possible diagnosis and offered me a RX for Prednisone.

I never heard of PMR and had a follow up appointment with the orthopedist in a few days so I said I would wait to see what he said.

That evening I read all I could find about PMR and when I woke up the pain was really severe and my hands were hurting something awful. 

I decided I needed relief and called my GP for the RX.  

He prescribed 14 days worth of Prednisone, 10 mg per tablet. Figuring Imwill be seeing my specialist and he can treat me.

Now 

fmy question. 10 mg seems low for an initial dose.  If it is not enough, should I expect relief, but not for a full day, or is it too low to even reduce symptoms?

 

0 likes, 14 replies

14 Replies

  • gilman
    gilman

    Posted

    I'm sorry for the typos but I was unable to edit my writing.  

    Yesterday, I decided  to increase my first dose to 15 mg and it made me 90-95% better.  The next day I took 12.5, but by evening the shoulders were hurting and by morning my hands, shoulders, legs were sore.  I took 12.5 again (today is my third dose) and things did get better by noon.  Not sure how the night will go.  

    I am am on my own until I see my orthopedist this week and wonder if I should just up things to 15 mg until my visit.   I don't want to use a higher dose which might make tapering take longer.   I suspect I will get referred to a rheumatologist but want to be pain free if I can be until I see him or her.

    Thanks and sorry if this was too much information clouding my question.

    i still want to understand what to expect if a dose is too low.  Will I have lesser symptoms or just not relief for the full 24 hours.

     

    • Anhaga
      Anhaga gilman

      Posted

      Naturally one hesitates to override the so-called expert but I agree with you that 10mg was too low.  15 is fairly standard and as you responded so well to that dose, yes, stay on it.  Find the Bristol paper which is somewhere on this site, sorry my device doesn’t permit me to locate link for you, and that should give you info to take to doctor toback up your decision.
    • FlipDover_Aust
      FlipDover_Aust gilman

      Posted

      I also agree that 10mg is too low for a starting dose... commonly 15mg is given - but there is a lot of variation, depending on your GP or Rheumy.  I was started at 50mg for a week! OMG it was wonderful!! lol

      Given 15mg has worked for you I'd be sticking to that dose until you see a specialist.

  • Silver49
    Silver49 gilman

    Edited

    I would agree that if 15mgs is relieving the pain then that would seem the most appropriate dose. I was started on 20 mgs for 10 days then reduced to 15mgs but I can't remember how long I was on  that amount. I was then reduced to 12.5mgs and had a mild flare whenI tried to go to 10 from there. I went back up to 12.5 for a week and then went to 11mgs. As previously mentioned there is a paper that is so helpful. We are all different and have different reactions to the steroids so it will act as a guide but you may have to work out the reduction which suits you. Eileen will give lots of helpful advice as will others on this forum. Do ask when you need advice. We are a friendly bunch.
  • gilman
    gilman

    Posted

    Thanks for the advice.  Today is my fourth day on prednisone and I woke up hurting at 4:00 am.  I grabbed a bite and took 15 mg.

    The question I have is will a correct dose keep me pain free unti my next daily dose is due?   

    • Silver49
      Silver49 gilman

      Posted

      Eileen will be able to explain why the pain is so bad at that time. I think it has been suggested that it is a good time to take the steroids as long as you have something to eat beforehand. You may not necessarily be totally pain free but a good 70% appears to be a reasonable expectation. Some are better than this. Some people are splitting their dose as it helps them to manage the pain better. I haven't done so to date so I can't say if I would find it better or not. I would expect 15mgs to be pretty effective. You will be able to gauge it better when you are in a pattern. Hopefully this amount will see you through to your next daily dose. I found it worked for me but we are all different and our bodies react in different ways to the medication.
  • reggie92967
    reggie92967 gilman

    Posted

    I too started on 10-day trial of 10mg, ladt July, & got incredible relief for approx. a month. Then went to 15mg for 3-months, helped but still wasn't feeling as super as I did that 1rst month. Then I improved so my Rheumatologist reduced by 5mg every other day, I had a crash &:was horrible for 5-days. He put me back to 15 then 17, it helped reduce symptoms, still not like that great 1rst month . Then went to 20, 21, up to 40, a 1-week trial, then down to 20, 18, 17 & currently reducing by 1mg every 2-weeks, to get back down to 10mg again. I feel some symptoms returning, nit terrible but aching, soreness, feeling overall inflamation, the fatigue, weekness is bad. Any ideas on weight reduction, I have gained so much weight, & now fighting high blood press., (it was always perfect), also get out of breath easily because of the extra weightm I was an avid walker, exerciser, kept weight controlled, now since PMR plus prednisone I feel like an overweight, out of shape, sedintary old man. Should I do a no/low carb. diet, & just force myself to walk as much as I can ? I don't just sit idle, I try to keep on moving, going, accomplishing anything, chores etc. I can. Oh didn't mention I could be the moonface poster boy ! THANKS
  • Achenpain1
    Achenpain1 gilman

    Posted

    I am wondering if I should expect all pain to be gone before lowering my dosage? I have lowered gradually from 20mg to 12.5 since September 2015. Still have sore neck and legs, it's uncomfortable worse in the morning.
    • Anhaga
      Anhaga Achenpain1

      Posted

      There's a balancing act. Pred is a dangerous drug.  We have to get our dose safely down to the lowest level possible while still enjoying the best quality of life pred can give us.  In my case it will be necessary to tolerate a low level of stiffness but I won't tolerate going to a point where I lose benefits of pred. Each of us has to choose for themselves where the appropriate level is.  Achenpain, you might want no pain, or you may be happy to tolerate a little,  especially as many of us have pain unrelated to pmr as well, which lower doses of pred won't help.  I don't know how many people on this forum remain completely painfree after the first few weeks on pred
  • artfingers
    artfingers gilman

    Posted

    That is precisely the dose I started on and it was fine for me.  My rheumatologist started me at 10, but I discovered I needed to take half in the morning and half in the evening.  It worked great.  I experimented a bit trying to go lower immediately but that didn't work.  You'll know if it works by level of pain (or not).
  • artfingers
    artfingers gilman

    Posted

    Well, per Eiieen's recommendation, I found that I did half in the morning (which in my case was 5 mg pred) at 8am.  Then half of COATED pred (called Rayos in the U.S.) at 10pm.  Because it is coated it kicks in just at the time around 2am when the cytokines are most active and it needs to kick in then.  So I found that worked best after a bit of trial and error.  I stuck at that dose for several months then began a slow, slow slow taper which I'm still doing (only at 7.5 mg now).  Good luck!
    • Oregonjohn-UK
      Oregonjohn-UK artfingers

      Posted

      It's worth remembering that you shouldn’t split an enteric coated pill (usually red in color), it OK with the white ones.  The coating dissolves slower and that’s why it can be taken earlier but not effective if cut and can lead to stomach problems!
  • ruth62999
    ruth62999 gilman

    Posted

    I think your GP is right on it.  I've had PMR almost 4 yrs. I started out having pain behind my knees, but then it moved to the front of the knee.  And shoulder pain is a sympton of PMR.  I don't think you need an orthopedic; I think you need a Rheumotologist.  They started me on 20 mg of prednisone, but I am off of it now and just use Aleve for pain. Hope this helps.
  • Bergey
    Bergey gilman

    Posted

    I would suggest that you get a consultation with a Rheumatologist.
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