Just diagnosed with possible PMR. Took 20 morning 20 nightime for 1 week. Pain was gone. Tapered nightime by 5 mg per day because I really didn't need nightly dose. This morning all the pain came back strong. I could hardly sit up in bed. I took 40 mg Pred 6:300 this morning. I'm better but stil very stiff. I new at 2am I was going to be in trouble. Probably should have taken 20 then. Waited till 4:30 for 20mg then 20 more at 60. Don't know what do do from here
Mary, it looks like you did need some of your dose in the evening. Why were you treated with 20 mg twice a day? The usual start to determine whether it really is PMR is 15-20 mg once a day for a week. Has your doctor any suggestions for you? If not, there will be others on here who will be able to give excellent guidance how to manage your predicament!
40mg is a very high as a starting dose for possible PMR - many things will respond to that high a dose. The usual starting dose for PMR is 15-20mg and to some extent forms a confirmation of the diagnosis - only PMR responds so typically with an overall 70% improvement in symptoms within a week or so. Using a higher dose muddies the waters and leaves you at risk of the many side-effects of high dose pred. The only reason for using that level of dose would be if you have symptoms that suggest GCA (giant cell arteritis) and the doctor thinks your sight is at risk.
I think you have to continue with the 20mg in the morning, possibly with some at night, and contact your doctor on Monday. Even 20mg taken once a day should be enough to manage PMR unless you really are a person for whom the antiinflammatory effect only lasts the minimum, which is about 12 hours in which caae splitting the dose may owrk better. Taking the pred won't work immediately - it will take 2 or 3 hours to be absorbed and start to work so don't panic again and take the double dose. You must be patient.
And the other question i have to ask - what were you doing yesterday and the days before? Did you assume you were fine and that you could catch up on all the things you hadn't been doing? Because if you did that would also account for the symptoms returning. This is a chronic illness and the pred is just managing the symptoms. The underlying cause of those symptoms is an autoimmune disorder which attacks the tiny arteries that take blood supply to your muscles. They are starved of nutrients and oxygen so are intolerant of exercise. You have to do your part and pace yourself and rest appropriately. Do things in small bites with rests in between. Overdo it and your muscles will behave as if you asked them to do a marathon without any training - and you will be stiff and sore.
A little background on me is that I had torn rotator cuff right shoulder. and went to orthopedist . He gave me a steroid shot a week later I woke up with severe pain in my left shoulder and my right hip went back to orthopedist he said it was bursitis and gave me a steroid shot in my hip and my other shoulder five days later I woke up and I had to go to emergency because I could hardly move. Hospital diagnosed we with steroid withdrawal and put me on 12 day taper. they gave me pain medication medication and put me on a 12 day paper pack of steroids saying that I had steroid withdrawal. Did good on taper but got down to 10mg and all the pain came back. WaIting for Dr appt went back in n 20. But night time pain bad in shoulders sl for 3 days I upped it to 20 at night. Still had shoulder pain only so I felt that was rotator not and thing else. So I did 5 mg taper every night for 3 nights to stop night time dose. Last night I was down to zero and the pain came back. Doctor finally called yesterday and said he thinks is pmr. Blood work on like showed a slightly elevated sed rate I know I panicked this morning and did the 40 but even now my arms and legs hurt. Doc wanted me to be on 20 for a month nth then repeat blood work. If I just do the 20 tommorrow morning I'm afraid I will be the way I was this morning which as really bad. Thought maybe do 10 with dinner for week then 5mg for week along with 20mg mornings. I have tried to rest but I do feel better if I take a little walk Can't see reumotologist because they are all booked to end April into May Sorry about the rambling but it's good to be able talk it. I have gotten so much information from these posts. Also, would that 3 day raise in dose and 3 days back down bring on all this pain?
No expert on this - but I really don't think you would normally get steroid withdrawal from 3 steroid injections over a week. You usually have to be on pred longer than that to have a withdrawal problem. My suspicion would be that there is more to this than meets the eye but see how you feel tomorrow. Maybe try 15mg in the morning and 10mg at night?
When I say rest I don't mean do nothing - I mean do a bit, rest a bit, rinse and repeat. And nothing heavy duty - no lifting stuff, repetitive actions like cleaning windows.
I don't know, that sounds like a lot of prednisone. The most I took in 1 day was 30mg and it was too much! It made me high and hyper. Doc. said stay on 25 which I did for 6 weeks and I felt great. Starting to taper now and I have some pain back but I am going to see what happens.
I haven't really had to many side effects yet. I'm beginning of o that no I'm dealing with PMR and Pred withdrawal. I'm going ask Doctor about doin taper of 5mg per week till I get down to 20.