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Proper Response to Flareup?

Posted , 15 users are following.

bob73443
bob73443

Hello all you wonderful people.

I've been diagnosed with PMR since last July and on prednisone ever since.  I used the gradual withdrawal method to get down to 10 mg/day and have been at that dosage for about 2 months.

But after coming back from a business trip last week, I think I'm in the midst of a significant flare-up.

Here's my question:  I'd rather NOT increase the dosage to deal with the flareup and just wait for it to simmer down on its own.  But is that possible?  Can the inflammation simmer down on its own or will I have to increase the dosage to deal with it?

Thanks all!

1 like, 20 replies

20 Replies

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  • EileenH
    EileenH bob73443

    Posted

    Many doctors suggest taking the currrent dose plus 5mg for a week or so to get the inflammation under control and then go back to the former dose - you don't need to do it so slowly.

    There are two, maybe three reasons for flares:

    a) the dose has been reduced too far to manage the symptoms caused by the underlying autoimmune disorder which has remained stable

    b) the underlying autoimmune disorder has increased in activity causing more severe symptoms

    c) you have been doing too much

    a) can be a bit tricky too - you might have reduced to a dose that is apparently adequate but it is just underneath what you really need. The inflammation was well controlled at a previous dose, say 11mg, and just controlled at 10.5mg. The drop to 10mg got you to a dose that wasn't quite enough to wash out all the inflammation every day and it started to build up very very gradually - like a tap dripping into a bucket that wasn't full to start with. Eventually though the bucket fills to the brim and spills over. Then - into the bargain you travelled and changed time zones maybe? Stress and messing about with body-clocks - not good with PMR.

    You could try and ride it out - and that will work if it is just you overdid it. But if the 10mg isn't quite enough it won't. And the sooner you hit the excess inflammation on the head the better. Three or 4 days of a bit extra now is far better than having to go higher or for longer if it doesn't settle down.

  • Mrs.Mac-Canada
    Mrs.Mac-Canada bob73443

    Posted

    Hi Bob,

    After having a few flares, the last one being particularly nasty, I would tend to bump the dose by 5mg like Eileen suggested so the inflammation doesn't get a good foothold.  I waited to long and ultimately had to to 10mg from 4mg. And that my friend was really, really frustrating😡.

    Best of luck to you!

    Diana🌸

     

  • Padada
    Padada bob73443

    Posted

    Thank you Bob for asking this question.  I have just experienced the same type of flare.  I recently had reduced from 15 mg to 13.5mg and was doing fairly well (pain was not gone altogether though).  We had company for the holiday this weekend and today I woke up with an increase in pain and stiffness and generally feel ill. 

    I believe the stress of the weekend with guests caused this flare.  I wish I understood  why stress can cause a flare.  It makes sense that overdoing it physically would cause a flare, but my weekend was definately more emotional stress than physical.

    ANyway, the information that Eileen gave on how to increase the prednisone to overcome the inflammation was so timely and valuable.  I increased to 15 mg this morning and will continue to take 15 mg for several days as she suggested, then go directly back to 13.5 mg.  I must admit that the thought of going directly back down to 13.5mg ( without tapering) is a bit  intimadating.   But I trust the information that was given. 

    Dealing with PMR and prednisone is so challenging.  It seems that there is no standard protocol that fits everyone and also that everyone that suffers from PMR has slightly different symptoms and issues to cope with.  Thank goodness that this forum has such helpful information to share with us newbies.  I am grateful for such good advice from people who have 'walked a mile' in my shoes. 

     

    • EileenH
      EileenH Padada

      Posted

      Careful Padada - if you still had some pain at 13.5mg you might be better reducing via 14mg to be sure that you are comfortable first. Even Bob may find he still needs a bit more on the way - it all depends on whether it really was the extra effort of travel/visitors. There is no way of knowing without trying though.
    • cindy63197
      cindy63197 Padada

      Posted

      Hi , it sounds as though you've at least made some progress overall. I'm finding too that the emotional stress seems to have as much impact as the physical. I've had to stay at 2mg prednisone longer than expected because of my father in law going in and out of the hospital 3 times in the last 2 weeks, even though my labs have been great.
    • bob73443
      bob73443 cindy63197

      Posted

      Thank you so much, all of you, for these responses. 

      The emotional factor is a big one for me as well.  For me, the PMR itself was triggered by some highly stressful times.  And I'm going through more of them right now, as we speak.

      I have wondered if a dose of valium, when we're going through this highly stressful times, might help.

      Thoughts about valium in combination with prednisone when inhighly stressful situations?

    • mary68968
      mary68968 bob73443

      Posted

      I tend to have anxiety issues & often use a half tablet of Xanax & seems to cut down on stress & anxiety.  Plus I think the pred makes me a bit hipper & easy to anger.  Also the Xanax helps me sleep.
    • ptolemy
      ptolemy bob73443

      Posted

      I had a terrible flare when at 10mg. I was so determined not to go up again and tried to ride it out. In the end my GP and my blood test results said increase the pred. I went up to 15mg for a very few days and was able to reduce to 12.5mg in less than a week and then slowly got back to 10mg. 
    • EileenH
      EileenH bob73443

      Posted

      Personally I would avoid even the thought of valium - but I have had a very bad experience with it! There are better medications to deal with anxiety and CBT(cognitive behavioural therapy)  is far better with fewer side effects.

      Learning to cope and live with stress is very important if it figures large in your life. Drugs don't sure anything and just cover up a problem while leaving you with another problem at the end. But then, I'm European and we do do things a bit differently!

    • EileenH
      EileenH

      Posted

      That should be "drugs don't cure anything..."  

      Much of the problem in the 21st century is that we expect an immediate solution to everything and that it should come in a pill - but that is not the real answer. Look deeper.

    • elizabeth20640
      elizabeth20640 EileenH

      Posted

      Ye totally agree with cognitive behavioural therapy helped me out a great deal with anxiety and stress, would you think PMA and GCA could be caused by stress
    • EileenH
      EileenH elizabeth20640

      Posted

      I don't think that PMR and GCA are caused ONLY by stress, no. But stress is definitely a contributing factor. It may be the final link, it may be historical but it is almost always there somewhere. Together with over-doing things physically and giving in to selfish family/friend/other demands. And possibly illness. 

      These are all factors in many autoimmune problems and really shouldn't be ignored. The few people we know who have had PMR twice have said they realised (too late) they had overdone things before the second episode. So be warned - be selfish: if helps get rid of it and helps avoid it coming back! 

    • Padada
      Padada EileenH

      Posted

      Thank you for that suggestion to reduce via 14 mg. I will do that. 
    • margo25238
      margo25238 bob73443

      Posted

      Regarding stress and emotional issues and sleep problems - i have been taking a drug called Elavil for quite a few years. Prescribed for me because at the time the gp felt i was not going into a deep restorative sleep at night therefore not giving my body a chance to reset  - some of my symptoms were simlilar back then, but no where near the severity of my recent PMR symptoms.  However, on the advice of my Rheumy, continue to take the Elavil (amytriptiline) I take 25mgs 2 or 3 hours before i turn in for the night - I sleep like a log and i am sure the deep sleep can only contribute to healing...and i wake up refreshed;

    • FlipDover_Aust
      FlipDover_Aust EileenH

      Posted

      Yup, I had the trifecta last year just before I got sick. 8 weeks of virus and chest infectsions, major drama with one of the ugly step-daughters, a breast cancer scare and an exhausting 'holiday'!
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