Is this my new normal?
Posted , 16 users are following.
Hi Everyone,
my dr put me on 10mg of pred last Wednesday for PMR, and told me that I'll feel great. Well I don't. In the morning I'm still pretty achey and stiff. It usually takes until the afternoon before I feel better. Is this normal, would this still happen if I was on a higher dose? Some of you said that 10mg is too low to start with, but it seems to be what they do in the U.S. I guess my questions is, would it help to push for a higher dose, or would I still have the morning pain until the pred kicked in? How do you know when you're on the correct dose?
it really helps to read about other people's journey with this, doctors don't seem to have a clue.
thank you
0 likes, 85 replies
Lee-Colorado Anniecurd
Posted
47/60 (78.3%) patients responded to 12.5 mg of prednisone after a mean interval of 6.6 ± 5.2 days. In univariate analysis, body weight and gender discriminated the two groups. In multivariate analysis, the only factor predicting a good response was low weight (p = 0.004); the higher response rate observed in women was explained by their lower weight. The mean prednisone dose per kg in the responders was 0.19 ± 0.03 mg in comparison with 0.16 ± 0.03 mg for non responders (p = 0.007).
Anniecurd Lee-Colorado
Posted
EileenH Anniecurd
Posted
As I've already explained, in using pred for PMR they have chosen a starting dose that works well for most people - 15mg is the standard but they say 20mg if 15mg doesn't appear to produce the required effect. So that extra 5mg already takes the weight aspect into account. You are using a dose that is considerably above what the majority require to get a faster grip of the inflammation and then you titrate the dose down to find your ideal dose - the lowest dose that manages the symptoms as well as the starting dose achieved originally. That dose depends on the person, the activity of the autoimmune disorder and the symptoms it causes vary from person to person.
That all means that there is no standard dose - so your weight is immaterial providing the starting dose was more than what you needed. The reason 15-20mg is used is to try to reduce the side-effects - we could all start at 50mg but the side-effects there are considerable. PMR is the only arthritis that responds to this moderate dose of pred in such a dramatic fashion - that also provides an indicator as to whether this really is PMR. Other inflammatory arthritides will also respond to the high doses so if you start high you don't have this indicator, they will respond too - but they also respond better to other drugs which have fewer side-effects.
The study cc is talking about was done to see if you could get away with an even lower dose - you can, but it takes longer to clear out the existing inflammation and it wasn't quite enough to cover everyone - so they didn't recommend that the top starting dose should be reduced.
cc's calculation doesn't take into account the activity of the underlying autoimmune disorder - and he is assuming that there is a linear relationship between the dose and how long it will take - there probably isn't. So someone who has a severe autoimmune activity will need more than someone who is only mildly affected - for them 10mg may never get the thing under control and then the assumption may be that they don't have PMR. So you have the same downside as using a high dose - you don't see the speedy improvement which really is so typical of PMR while it doesn't happen with a patient with pMR symptoms caused by something else.
Lee-Colorado Anniecurd
Posted
100lb = 45kg
45 x .2 = 9mg starting
5' 2" eyes of blue = 10mg
just remember, it will take 1 to 12 days according to this study to feel,the effects.
PMR data only...
Lee-Colorado Anniecurd
Posted