After 8 years of PMR I have relapsed AGAIN

I agree with you. How long should you stay at 10 mg before going higher if you don't get better at 10 and then how much should you go up to next?

It's hard to say Gene. Depends on how you're feeling and your own sense of what might work for you.. The decision is very much a personal one.

For example, in my case, if my PMR symptoms began to niggle a bit at 9.5 mg, I'd still wait a few days to see if they get worse. If do, I'd likely go to 12 mg because that resolved my previous minor flare. In that case I stayed at 12 for only 4 days and it almost 6 months to get back to 10! Someone else would find that totally crazy.

I believe it's possible for some to go up 5 mg for a week or two and drop right back to their previous dose.

Sorry, I'm probably confusing you even more.

Your not confusing me at all. I am just not sure how long it takes at a certain dose to get relief and not really how long to wait when pain starts getting worse. For instance I took 6 mg for 3 weeks while tapering down and I got so bad off I went to 7mg. I stayed at 7 mg for 3 days, went to 8 mg one day later, next day to 10 mg and today I went to 15. 5 hours later I feel much better. I will stay here for a while and see how it goes. I probably should have gone slower, but I was in need of relief.

The main thing is you have the relief you need.  That's great.!

Personally, when I had a bad flare from reducing too fast from 15 to 10 mg, for me, in year two of PMR, inching up didn't work. I only denied and delayed the inevitable. I eventually accepted going back to 15 and there for two full weeks before starting the DSNS dropping .5 mg at a time.

I can't tell you how many lessons I've learned Gene and many were learned the hard way. 

Good luck and don't rush.

Jean, I agree with you, hit the flare hard, get the inflammation under control and then reduce quickly to the high level of your DSNS taper. When I didn't do that and followed my Rheumy advice I got in trouble. Lesson well learned! Thinking positive with a smile. ??

There really isn't an answer - everyone is different: there is the activity of the underlying disease, how you personally respond to pred as not everyone absorbs the same amount, how much activity you are doing, other problems that can contribute to how you feel.

You really should have given 10mg a few days to work - it would probably have saved going back to 15mg. And when you taper, a good rule is you shouldn't feel any worse after the taper than you did before it. If you have any return of symptoms - go back to the previous dose immediately and wait a few weeks, then try again. Often that is enough for it to work. If the symptoms return a few times at the same sort of dose it is your body telling you that you have reached the lowest dose that manages the symptoms - which is what you are looking for. It doesn't mean you won't get lower - just not yet. Using one of the slow reduction approaches you will find on the forums where you challenge your body with the new lower dose just one day at a time with a few days of the old dose in between means that your body notices the change in dose less - and you are less likely to suffer steroid withdrawal discomfort. It can be so similar to PMR you don't know which it is. Many people panic and go back to the higher dose, thinking it is a falre, when really if you were patient a little bit longer it would settle down. Steroid withdrawal happens as soon as you change the dose and then gets better over time - a flare usually takes several days to start and then gets worse over time. 

A lot of experts say that if you have a flare, a good way to deal with it is to add 5mg to dose where you flared for up to a week. Then go back to 1mg above the dose where you flared. That often is enough and you haven't wasted all that tapering you worked so hard at. As jean says - inching up rarely works well.

But if the flare is not because of overshooting the dose you want and is because the underlying disorder has increased in activity then you MAY need to go back to the beginning because two flares of that sort are rarely the same and you don't know how much will deal with it.

I decided to take your advice, so I am going to try 11 mg for a week. I got a powerful response from 15 mg. I guess I overshot,but I have been trying to get stable since last September. I appreciate everyone's help. Sincere thanks .

Thank you for your opinion. Your situation sounds a lot like mine. I don't think I will ever be off of prednisone,but I am not worried about it. I would like to be on a low dose and be in a tolerable situation. Until I got on the internet, I never have talked to anyone who has PMR. When I first got this stuff the doctor said it only lasted 6 months to 2 years.

"When I first got this stuff the doctor said it only lasted 6 months to 2 years."

In his dreams!!! I do wish I knew where they get these ideas from. I have read an awful lot about PMR over the years - and 6 months to 2 years has never figured anywhere! Nor have I met many people whose PMR went away that quickly - a few with 2 years but none significantly less.

I can only assume that when it doesn't go away in 2 years they decide it isn't PMR and give up on the patients. Or they misdiagnosed patients with palindromic or reactive arthritis as having PMR.

The trouble is most of the literature mentions around two years as if that is a sort of maximum, which then gets stuck in their heads. It does not really stress it could be a lot longer and if a longer time is mentioned it just sounds more like an afterthought. Or perhaps they don’t want to depress their patients by saying you could have it for a long time right at the beginning. I was really told nothing about the illness just take pred and you will be running around when I next see you as if nothing has happened. 

I am sure I have PMR. I have read everything I could find about it. When I read these articles it's like they are taking specifically about me.

Gene, I do not know where the Rheumatologist are getting their information, but article after article some of which are on the forum web site are stating that PMR last much longer, if not for ever. It is a shame that they are not reading the updated information from their own associations. Good luck think positive and try to smile. ☺️

Yeah right - you could have them under the Trades Descriptions Act maybe?

Good thought. Their defence would probably be that they are unable to read!

PMR isn't the only thing here that I gain an education about.  This Yankee is thinking...."Trades Description Act????" so of course I had to look up what you were referring to!  Such a nice title for laws dealing with skullduggery.

TheRaven, this old SwampYankee just learned something new also. Always learning on the FORUM! ☺️

We've just had a thread over on the HU forum saying much the same thing!  OTOH - calling it the Skullduggery Act would be SO much more apt... Particularly given the current gubmint!