Concerned about recommended Prednisone Reduction

First of all, Meloxicam is one of a group of drugs called NSAIDs (non-steroidal anti-inflammatory drugs) and NSAIDs should NEVER be taken regularly alongside pred at any dose. Both are capable of causing gastric problems by irritating the lining of the stomach, taking both together increases that risk. 

Reducing from 20 to 10 mg pred was NEVER going to work in PMR even if it works in other illnesses where pred is used and tapered. The dose of 15 to 20 mg used as a starting dose in PMR is one that deals with the inflammation that is causing the symptoms in most people. Then you need to reduce to the lowest dose that does that. What we call PMR is just the symptoms of an underlying autoimmune disorder that causes your immune system not to recognise your body as "self" and so it attacks various tissues leading to inflammation and swelling which cause the pain because of pressure on muscles, tendons and blood vessels. All the pred is doing is controlling that inflammation and relieving the pain.

Fatigue may well be not talked about in many sites - the ones I frequent mention it a LOT! The pred won't do anything about the fatigue, that is a component of the autoimmune disorder and the only way to manage that is to rest - you'll still feel fatigued but it will be easier to manage to do things. If you are still working that will compound that - very few of us would have been able to hold down a "real" job where we had to get up and do things to a timetable, cope with commuting and so on. I worked all the way through - but I am a freelance translator, my office was a few feet from my bed, I could choose my hours and never had to get dressed up never mind go out of the door!

It is possible that you have a rather atypical version of GCA - some people complain of ear pain and problems. About 1 in 6 of patients with PMR go on to develop GCA at some later point. Have your blood tests been repeated regularly? Did your ESR and CRP rise originally? Did they fall and have they gone up again?

When you reduce you must keep the steps small - the top experts recommend not more than 10% of your current dose (20 down to 10 was a 50% reduction!). Even the 2.5mg drops so beloved of many doctors is too much for many people - and it is a problem that gets worse over time. The body gets used to the current dose of pred, take some away and it is akin to going cold turkey - the body protests. Unfortunately the protest is in the form of symptoms that are similar to the original illness for which you are taking the pred.

If you follow this link to another thread on this website:

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

you will find some other links to reliable sites and forums with large amounts of info. One is the support site for the northeast of England PMR/GCA charity and the final one in that first post is to a paper written by the rheumy group in Bristol, England with recommendations for management of PMR and gCA, aimed at GPs. it is fairly easy to read most of it and your GP could do with a bit of bedtime reading. So could your rheumy but I doubt she would listen to a mere "internet" recommendation. I might be wrong.

Be that as it may, further down the thread, the 4th and 5th posts I think, is my "dead slow and nearly stop" reduction plan that has allowed a lot of people to get far lower than every before - because it IS so slow and the body doesn't protest at the reduction. I always got stuck at 9mg - now I'm almost at 3mg. You still reduce at the rate of 1mg/month - far faster than rushing and having a flare and needing more pred again.

However - first of all I would discuss this all with your GP. I am very concerned personally about the meloxicam - not just because of the gastric aspects but also because it is associated with a high rate of cardiac side effects. Your PMR is a vasculitis, inflamed blood vessels, and long term can lead to cardiovascular problems. One of the contraindications for meloxicam is problems with blood vessels or circulation. In my book that includes vasculitis.

Tinnitus is a listed side-effect of meloxicam - it can have an effect on the ears. So can PMR/GCA - I had ear problems, tinnitus and sharp pains, for some time in the early stages. I don't know how long I had been on pred before it disappeared.