Missed dose

If you feel OK on 5mg then your arenal glands are probably starting to function again, if they aren't you tend to feel more tired rather than less so as you reduce the pred. But this is the point you need to continue as you have been, not speed it up, more for the adrenal function than the PMR. As you reduce the adrenal gland set-up has to adust each time - and probably adjusts a small amount more easily than a large amount. 1mg per month is probably a good compromise.

One very good doctor keeps people at 5mg for up to 9 months - I see why, but if you are able to continue reducing steadily I think that is probably better as you can see the progress and it is encouraging. If you start to feel more and more tired though - that's a sign to stop where you are and let your body catch up..

I used to take my pred on alternate days - and could comfortably go the 48 hours between doses. It may mean that you would be just as comfortable on 2.5mg a day but that's a big jump and I wouldn't recommend it. The antiinflammary effect of pred lasts for 12-36 hours - so what happened would be normal if you are a 36 hour person.

Usually over time there is enough fluctuation in one's dosage requirement so as to cause perceptible symptoms from time to time.

If you have been free of all symptoms for some time, then I woud suggest that it is time to have a go at your next reduction, perhaps reducing from 5mg to 4mg every other day, reverting to 5mg/day only if symptoms become persistent.

And I would recommend at this time when your symptoms are at a minimum, that you take advantage of your ability to sustain some level of increased physical activity early each day when your metabolism is near it's peak. There is strong correlation betweenthe body's metabolic functions and immune activity, and increased morning activity has always led to my ability to achieve further reductions in dosage.

Since we are not "working out" like weightlifters do, our muscles shouldn't need 48+ hours between such efforts, and I do best with a certain level of daily exercise that I can sustain over time, even light weightlifting, brisk walking and short bouts of jogging, in addition to my daily bicycle riding. By all means avoid sitting for longer than a period of minutes when symptoms seem to "flare".  Better to lie down for 30 minutes or an hour than to sit for that long! 

Oh, and 5mg is still a VERY significant dose of prednisone, you will not be able to just quit taking it, trust me on that.

I had an unusual experience last week.  Because of a stomach bug I definitely missed a dose and may not have absorbed much if any of the previous one.  I did not have any PMR pain.  In fact I felt better, that way, than usual.  However the morning of the second day I developed a persistent fairly severe headache, not excruciating like migraine but bad enough I couldn't read, listen to the radio, etc.  I also found myself weak, hauling myself upstairs by the banister.  Around four in the afternoon I decided I could keep down some food and took a dose of pred.  Within four hours the headache was gone and I felt like a whole new person.  I have taken advantage of this event to stay with a new low dose of 2 mg, had been at 2.5 and having a difficult time tapering.  I wonder if being without pred for that time sort of kickstarted something?  In any case a week has gone by and so far so good....