very low energy, no get up and go....

I don't know your story. Margo, but low energy and weakness come with PMR, however long you have had it, and however many mgs you are on.  The experts will no doubt answer, but alone this wouldn't suggest a flare.

Not necessarily, Margo, but it needs to be watched in case inflammation is resurfacing.  If it has only been going on for a few days, it could simply be that your have some infection or virus lurking.  If you had raised markers of inflammation at diagnosis then do get the tests repeated to see if they reveal anything.  If it's been going on for longer, then perhaps a return to a slightly higher dose will give you the answer.

Hello margo, I'm sorry to hear you're feeling so fatigued. I am presently on 8mgs and my rheumatologist said that once I get to 7.5ish mgs my adrenal glands should be trying to kick in again and so I may experience some fatigue. If it's only sporadic then not to worry but if it happens daily for long periods I should get myself back to my GP as the adrenal glands may not be working as they should do and this is something that must be looked into. In your case you are on 6mgs of steriods and this is below the amount the body normally makes so if your adrenal glands are not working properly your body is not getting enough steriods to allow the body to work and function properly. 

Having said all that it could be that you are suffering a flare because fatigue is a side effect of PMR. Maybe you should visit your GP and take it from there.

how long have you actually been on 6mgs and when did the fatigue begin?

hopefully others with far more knowledge will be along soon to offer much better advice. All the best, christina 

How quickly have you gone down from 10mg to 6mg? What size steps and how often?

As Christina has said, below about 8mg your body has to start to produce its own corticosteroid, cortisol, again. While you are on higher doses of pred there is enough sloshing around in your system to make domestic production unnecessary but about this level it has to get going again.

It isn't a case of your adrenal glands not working but the production is controlled by a very complex feedback system involving the hypothalamus, the pituitary and the adrenal glands (and other bits too) and a whole range of hormones. It is a major balancing act and a change in one bit affects all the rest so they have to rearrange themselves to get balanced again and that can take a few months. Below 10mg many doctors tell their patients to reduce at 1mg per month - and many have problems as a result as their body simply can't keep up. By reducing SLOWLY you can give it a better chance to manage - MrsO's doctor tells patients to stay at 5mg for up to 9 months - but some people get into a wobble above that. 7/7.5mg is a common sticking point, mostly for this reason. Lots of people are fine - but others aren't and the most common symptoms of this "adrenal insufficiency" are increasing fatigue and weakness. If you were to continue reducing you could end up with a real adrenal insufficiency crisis which can be quite a serious matter.

I wouldn't reduce any further for now, stay at 6mg until you feel better. If it doesn't improve the easy answer is to go back to the dose you last felt well at and then reduce more slowly once you feel better - but I know you don't want to do that! If you suffer from adrenal insufficiency the only answer is to add a bit more pred so it may be needed. On the other hand, if you feel reasonably well then just hanging about where you are now for a few months and avoiding stress and over-exertion may be all that is needed. And then do 1/2mg reductions - and preferably spread them over a few weeks as in the "Dead slow and nearly stop" reduction plan which is in the replies here:

https://patient.info/forums/discuss/pmr-gca-website-addresses-and-resources-35316

Although I don't have nearly the knowledge of others who have answered you I just wanted to add something. 

After my last flare, I had to increase to 25 mg from 13 to get relief from the pain.  

Before that time on the lower dose I never felt the extreme fatigue.  However, shortly after going to 25 mg the fatigue I felt became debilitating.  Everything was an extreme effort even walking from one room to another.

After  splitting the dose and with about a good week of time time I felt normal again and no longer feel any fatigue.  This leads me to think whether we go up or down on the dose our body needs adjustment time and perhaps increases also shouldn't be so drastic and taken more slowly.

I am dealing with the same thing pretty much.  3 times in the last 8 months have tried to reduce below 8 mg to 7 or 7.5 and each time have hit a road block.  Presently back up to 8 mg and probably could benefit by going up a little more but really don't want to backtrack anymore than have to.  My rheumatologist suggested that I stay at 8 mg for a few months to get things stabilized again.   I have been dealing with fatigue and no get up and go for sure.  My rheumatologist suggested the fatigue is due to steroid withdrawal and pmr relapse combination.  I really appreciate Eileen's response explaining some of the detail of the adrenal function. Better explanation than from my rheumatologist.  Good luck and better health.