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I just started prednisolone yesterday morning. I could hardly walk when I got up in the morning

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douglas13827
douglas13827

BY 7 pm i was doing so much better. ALL my aches and pains were much reduced. However this morning I am hurting again -not quite as bad. Is this how it goes?I guess i just expected to feel better each day.

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  • Dirk_St._Clare
    Dirk_St._Clare douglas13827

    Posted

    Good morning, I have been on pred for 2 years, I have always split mine up, reduced from 15mg down to 3mg I take 2 with dinner at night and 1 in the morning with breakfast after I have had a work out in the gym at 06.30 hrs. But I found that they take about 5 hours to kick in on me, this means I get a good nights sleep and wake up in the morning ok. In the morning just take the 1mg and keep active this keeps the pain away. It works for me, I am hoping by the end of 2019 I will be off them all together.

    MY age does not help being in my 70's

  • Duffer55
    Duffer55 douglas13827

    Posted

    I just saw another doctor, an internal medicine doctor, who half diagnosed me with PMR. At least he is aware of the condition. However, even though I present with all the symptoms he isn't convinced that is what it is. The fact that I told him my left arm is worse has him convinced it could be rotator cuff. I have never heard of anyone having butt and hip pain, sore calf muscles, etc with that! I have been on 2 --20 day regimen of pred. tapering 10 mg every 5 days starting with 40 and going down to 10. I kept data and the pain was better at 40 and increased as I got down to 10. His rationale for thinking it may not be PMR was that at a dose of 40 I should have been pain free. I argued that it was only for 5 days so I feel that maybe that would be the case if I were on for a couple of weeks. None the less, he did give me a 30 day script of 20mg to take and is going to fast track me to see a rheumatologist. The usual wait is approximately 9 months. How long should I take this dose if it works before I start to taper down? How will I know if the 20 mg isn't enough? He seems to think I should have no pain. I tried to explain to him that the pain and stiffness goes away around 10:00 or 11:00; but the pain never goes away completely. I am just able to move better.

    • EileenH
      EileenH Duffer55

      Posted

      Why on earth can't they go about things properly? And understand the way PMR works?

      What time do you take the pred dose? Every morning the body sheds a new batch of inflammatory substances about 4.30am-ish. They cause inflammation and new symptoms - and the sooner after that you take the pred the less it has to do and the sooner you will get relief of the symptoms. Pred takes a good couple of hours to work in anyone, it may take longer in others. Some people are never totally free of pain and it also depends what pain it is. If you have tendonitis and/or bursitis it will take longer to fade - my hip and foot pain took a good 5 months to go away. In some people the anti-inflammatory effect of steroids doesn't last a full 24 hours - it varies from 12 to 36 hours. If you are at the shorter end of the spectrum you will have pain in the morning before the new dose of pred kicks in. It is very common.

      If it were me, I would try the 20mg split into 15mg in the morning and the rest later so the effect lasts longer - and that may improve the morning pain. Try it before telling the doc...

      This describes a fair approach to managing PMR:

      http://www.rcpe.ac.uk/sites/default/files/quick.pdf

      and this:

      https://www.rheumatology.org/Portals/0/Files/2015%20PMR%20guidelines.pdf

      recommends a starting dose of up to 25mg, exceptionally 30mg.

      So you need to stick at 20mg for at least a month, possibly 6 weeks. And, to boot, you need to rest in the meantime. As long as there is inflammation it will worsen if you use the affected areas - especially the bursitis in hips and shoulders.

      I do hope you get into the hands of someone sensible soon - because how can you blame all that you have on a damaged rotator cuff!!!!!

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