Taper in meds and flares
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I started on 10 mg in December 2017 when first diagnosed, My rheumatologist is very conservative and does not want to increase too much to avoid the terrible side effects of the Prednisone. At the end of January The aching and fatigue was getting worse so he upped my dose to 15mg. In February I was back to 10 mg feeling okay. Now in April I am down to 6 mg, feeling pretty ok - odd aches in my fingers and feet in the evenings but generally ok. Is it normal to be able to reduce this low this quickly?
on another note I had blood tests and my GFR ( kidney function) came Bach as moderately diminished function (stage 3) - is this a common PMR thing? I am and was a fit 52 yr old who strength trains daily. Creatinine is up to....
Any feedback?
thanks!
0 likes, 2 replies
Anhaga Cyn1965
Posted
If you metabolize pred efficiently I suppose it would make it easier to reduce. Just for comparison, here's my experience: I went from 15 mg to 7 mg in about six months. The "terrible" effects of prednisone are not usually as terrible as made out at the moderate doses we take for PMR - this is from someone who has experienced increased blood sugar, higher than normal ocular pressure, possibly bone thinning, and now steroid induced myopathy. All of these side effects can be helped, all reduce rapidly as the dosage comes down.
I recently had a slew of tests as I'm getting on in years and my doctor and I thought it a good idea to have a baseline for things. All of my test results were normal, including kidney function, after nearly three years on pred.
EileenH Cyn1965
Posted
It is time your rheumy got up-to-date - there are no "terrible effects of pred" at PMR doses, nothing you wouldn't find in an age-matched population not on pred.
https://www.medpagetoday.com/rheumatology/generalrheumatology/66912
The international guidelines for management of PMR (issued jointly by the USA and Europe)
https://www.rheumatology.org/Portals/0/Files/2015%20PMR%20guidelines.pdf
say the lowest effective dose in the range 12.5-25 mg should be used to start. And not lower (because it so rarely works).
However - if you start on the right dose, clear out the existing inflammation properly and then start to reduce sensibly, if the dose you are looking for, the lowest dose that manages the daily boost of new inflammation as well as the starting dose, is lowish then you can reduce quite quickly. You might be fine on 6mg - and not fine on 5.5mg so it is difficult to give timetables.
What had you eaten the day before the blood test where your GFR (I assume eGFR) was lowered and your creatinine raised? If you had had a good steak the night before, that can be enough to raise the creatinine (it is a measure of protein breakdown in the body, any protein). If you had also had the blood taken fasting you could have been dehydrated and that also lowers the GFR calculated from the blood test results, the eGFR). So if your doctor is worried he should repeat it with you not having eaten steak and having drunk plenty before the blood is taken
. And if really worried - then you can get an accurate GFR by taking a 24 hour collection of urine and measuring the creatinine during that time. The eGFR given on lab reports is an estimate made on the basis of assumptions - introduced as a research tool to see if you can screen for renal disease using just routine blood tests.