Down to 15 mg. (I'm only 49, could this be PMR)

hi snoopboxer.....jeezzz, you're about the 3rd person on this forum in the past couple of days who's under 50yrs of age! Not that, that's a bad thing, it's just kinda unusual.

I started on 15mg about 8mo (or so) ago. I'm still at 12 and trying to slowly taper as quickly as I can as the side effects have been horrendous!

have been at 12mgs for about 4-5days right now. my hands and fingers are very stiff and my forearms are somewhat painful, but not intolerable.

will stay at this level till next wk, then plan to drop to 11.

please keep me posted as to how you are doin!

Hi,

I am relatively new to this forum, and have seen your post and no doubt Eileen can offer her specialist insight.

I am in the process of getting confirmed whether I have PMR or not and have been on Pred since Sept via my helpful Dr, starting me off with 15mg per day before an appointment with a Rheumy. I am now down to 10mg after a good 4-6 weeks of tapering, but I cant see why your Dr would be advising of such a quick reduction after you beginning at 20mg and being pain free.

I am 47 and this has thrown me and no doubt it has thrown you also...I would suggest going back to 20mg if possible to get back to some comfort and then look to taper down with the recommended tapering programme over many weeks which I am sure Eileen will provide you with the link for your review.

Best of luck!

Usual starting dose for PMR is between 15 and 25mg, so 20 was normal starting dose. If is it PMR, then usually treatment requires you to stay on starting dose for 4weeks or so, before trying to reduce. This is because you need to take care of accumulated inflammation before attempting to reduce. Reduction has to be gradual and it is a recommended to not reduce more then 10% of the dose, so at this level it would have been better to go in 2 or 2.5mg steps ( 20, 17.5, 15, etc.) . Prednisone does not cure PMR, it only manages inflammation, which causes pain. When reducing you are looking for lowest dose that manages symptoms and your reference is how you felt few days after starting dose.

There are two phenomena that could happen when you reduce dose.

Steroids withdrawal could happen immediately after reduction . Symptoms are similar to PMR but it should go gradually away after few days , maybe even a week or so. That is your bodyu reacting to reduction.

Second phenomena is a flare. It starts several days after reduction, same symptoms and PMR and it gets worse over time. If this happens it is wise to up the dose +5mg or so for several days and then go back to a dose before your reduction.

In your case it sounds more like steroid withdrawal, caused by large reduction . You may want to talk to your doctor and consider 17.5 as mid step in reduction. As far as the timing, you probably should stay at 17.5 ( it it works ) or go back to 20mg and wait for rheumatologist's appointment, IMO.

Yes, it is too fast a reduction - if there is any left over inflammation still hanging around it won't take a big reduction to allow it to break through so most sensible reduction approach leave the patient at the starting dose for at least a month before starting the taper. But in tapering the recommendations are to not exceed 10% of the current dose for each step: what you have just done is 25%. You might have managed 17.5mg OK but it is impossible to know. I think you have overshot the dose you need at present since the pain took a few days to appear - but it COULD be withdrawal pain, your body objecting to the change in dose, though I doubt it because you hadn't really been on pred long enough and withdrawal usually, logically enough, appears immediately the expected dose doesn't appear.

Honestly, sometimes I wonder about their use of logic - would he be stumped a week or two after your 50th birthday? And if he bothered to look it up he'd see that up to 20% of patients have blood markers that are in normal range.