PMR and Fatigue

it helped my fatigue.

i would try it. 

Over the last two years of my prednisone treatment, my tapering dosage has at times been sufficient to powerfully control my pmr skeletal symptoms. This seemed best when I passed through the 10mg range 1-1/2 years ago. This was also when I was not experiencing any noticeable amount of fatigue.

When I got down to about 5mg, I began to have to "extend" my dosage reduction timetable in order to more tolerably manage my pmr symptoms, taking only the minimum amount that I really had to. I spent almost a year at around 5mg per day. 

So while I have endured some level of pmr symptoms in order to "force" a lower dosage level, I have also endured the return of a certain level of fatigue, especially during hard exercise.  I am currently dosing at a just-tolerable 2mg/day, which I split, so I am taking 1mg at 6pm and 1mg before bedtime, which controls the worst of the symptoms when they would otherwise be at their worst.

I recommend staying as active as possible throughout the day, particularly in the morning, and making fine adjustment to dosage levels and times to control periodic flare-up of the worst (at the time) symptoms.

Symptoms tend to wander about thoughout the body and fluctuate in intensity, so real-time adjustments to dosage can be effective, but with GCA/TA one should probably respect their physician's prescribed minimum dose.

I don't have any GCA symptoms, so took over my own daily dosing "prescription" with real-time adjustments toward the minimum that I can endure.  I was able to reduce from 5mg to 3-1/2mg back in November, and from 3-1/2mg to 2mg just last week.  Both reductions were greatly facilitated by hours of daily exercise that better weather permitted.

I also declined to begin taking the Plaquenil (hydroxychloroquine sulfate, 400mg/day) that my rheumatologist very recently prescribed.

Good luck with your symptoms!

The pred reduces the inflammation that is caused which reduces the pain and stiffness to allow a better quality of life in the meantime while the disease is active - but it doesn't have a great deal effect on the underlying reason and the muscles remain intolerant of acute exercise - they can't tell you that you are doing too much and take far longer to recover than they would normally - and are easily fatigued. The Holy Grail of PMR/GCA will be to find a drug that DOES change that underlying immune process - not available yet though it could possibly be on the horizon, at a price: $17,000/year!

What probably happens in PMR is that the tiny blood vessels that supply the muscles with oxygen and nutrients become inflamed - so narrower and the supply route gets clogged up. After exercise the waste products aren't removed as quickly and efficiently - and you get sore muscles as a result, as if you had done some really strenuous exercise. As far as your muscles were concerned it was. 

Dan speaks about using exercise to help - that is a very individual thing and tends to be something that people who did athletics or similar prior to PMR and who were well trained can do - their muscles are at a better starting point, and that particularly applies to men. Certainly, getting your blood vessels dilated will help the blood flow - some people manage that by using an electric blanket in the morning before getting out of bed, stretching gently in a warm shower, gentle exercise and building up what they can do. But some people can't manage even that - so you have to work out for yourself what your own limits are. Then try to build that up slowly and gently - but no exercising to exhaustion (which some physiotherapists who don't know about PMR may try to get you to do). Just because one person with PMR can do something does NOT mean someone else can. Don't ever measure yourself against anyone else.

Since you are on 40mg I'm assuming you have suspected GCA - because it is too high a starting dose for PMR. The recommended maximum starting dose is 25mg, in exceptional circumstances 30mg and really not higher - it can mask other things and confuse the issue.

GCA is a potentially very serious illness - and really, having some time off to rest will help a lot in the early days. There are people with GCA on the forums who still work - but they often struggle and it is unfair to your body, which isn't well and needs some rest to recover. The same applies if you have "just" PMR - though it is sometimes more difficult to fit into normal life than GCA because of the physical effects. Many of us find even having ordinary visitors is too much, children around is really stressful - and the thought to having loads of them under feet just makes me fell weak at the knees - even if the PMR wasn't already there!

Google "The spoon theory" by Christina Miseriando for an allegory of living with any autoimmune disorder. By the time you have finished your day's work you have used up all your spoons - none left for you to feed yourself...