They are both corticosteroids and do the same thing but some doctors think that methylpred is more effective than prednisone - others don't. Here in the UK we are given prednisolone not prednisone and the difference there is that prednisone has to be metabolised by the liver to turn into prednisolone so presumably prednisolone is available to the body quicker plus there is less risk of liver problems. I imagine that applies to methyprednisolone too. Also, the dose given related to the effect is more predictable with methylpred. One of the problems with prednisone is that the amount needed to achieve a particular blood level varies from patient to patient so a 15mg dose in one patient may work better than in another person.
The primary difference for you Jannie may simply be the dose - you'd have been flying on 40mg if you just have PMR as that is the sort of dose for GCA and the starting dose for PMR in the UK would be 20 to 25mg. It sounds, though, that you have bursitis in the hip joints that isn't being controlled at your current dose of steroid. That is inflammation and won't be helped by tramadol (your docs in the US seem dead keen on using that - why? It's an addictive drug
I feel for your hip pain though - that was one of the main problems when the PMR was really bad 2 years ago and I've had it again during flares as well as foot pain that stopped me even walking inthe house never mind any further afield.
Hope you get sorted out soon,
Eileen
Update - methylpred is felt to be more effective with fewer side-effects than other corticosteroids - quote from the British Association of Rheumatologists Guidelines for the diagnosis and treatment of PMR.
So there you are, there's their reasoning.
Eileen
Freesia and Mrs. E.,
Thanks so much for your always welcome and valuable insight. It really helps to hear another perspective! After I posted yesterday, I called my pharmacy and talked to the pharmacist. He told me that it just might make a difference to switch to regular prednisone for awhile because their chemical make up is a bit different, and maybe that would be enough to help me.
I also talked to the nurse at my rheumy's and Mrs. E., I know you're right about that one. It wasn't the doctor's fault, but hers. She was soooooo apologetic and called me right back this time! I'm really thinking that this is PMR pain still. It's in my shoulders, too and I did have an MRI and other scans to rule out bursitis.
Off to work,
Thanks so much. I'll let you know what happens
Gentle Hugs, Jannie Glad things are going better for you, Jannie!
Hi Jannie,
Glad to hear you got things straightened out with the rheumy office. I have found that it sometimes takes persistence, plus it ends up to be a mistake like what happened to you. I take Tramadone 50 mg at bedtime so that I can override the pain and get some sleep. It works about 3 hours, then I take 2 Tylenol. My rheumy would also rather increase the Tramadol than the Prednisone. But I am reluctant to do that since the Tramadol has habit forming tendencies. Not sure about the prednisone question. I am on just regular prednisone.
Hope you are feeling well today.
Hi there,
I heard back from my rheumy's office while I was at work this morning (boy, are they trying to make up for the last two times!) She's phoning in some regular prednisone for me, both 5 mg. and 1 mg. tablets so I can taper more slowly. She said that the comparable dose of the 9 mg. of methylprednisolone that I was taking is 12 1/2 mg. of prednisone. I'm thinking this means that I was on an even lower dose than I thought (when comparing to what you are all taking and also that I was reducing at much too high a percentage) Does that make sense?
I'm still struggling with the pain, but at least I have some hope today. I'm also hoping I can quit taking the tramadol. I didn't realize it was addicting, or I would never have taken it!
Thank you so much for your kindness.
JannieOops, I don't know what I was thinking about with the comparable doses! I guess that's why I don't teach math...
I've basically been taking the equivalent of 12 1/2 mg. of prednisone. Guess I have farther to go than I thought.
Jannie
12.5 mg of prednisone is not such a high dose! I didn't realize that there was a difference in dosage between methylprednisolone and prednisone. I hope it helps you, Jannie.
freesia2011-05-13 19:56:55Hi,
Just wanted to let you know I started on 14 mg. of prednisone on Friday. My rheumy wanted to start me a bit higher to get the inflammation under control. Then 13 mg. for the past few days. That burning hip pain has really improved! I'm thinking of going to 12 1/2 starting tomorrow. Would that be too fast of a taper? Then I'd stay at 12 1/2 for a couple weeks before going down another 1/2 mg. I'm glad I have the 1 mg. tablets. Now I can be sneaky like you, Mrs. E, and taper more easily.
Now I just have to try not to overdo it on good days. It's hard not to this time of year with everything I want to do outside. Hope you are all feeling well. Freesia, are you over your flare?
JannieJannie
I'm so pleased to hear that increasing the dose has improved your pain but I do think that having already reduced from the 14mg, which you started only on Friday, to 13mg now, to consider reducing again at this stage would not have given the dose long enough to really get the inflammation under continuous control especially in view of the previous problems you have had. It would be preferable to stay on 13 for at least a couple of weeks and then try 12.5 for another couple of weeks. To do otherwise would, I feel, just result in continuous yo-yoing of the dose - the body needs to stabilise at one dose before attempting a reduction.
Very best wishes that the present dose holds.
Jannie - GOOD! Less pain is always a good thing. But Pearl is absolutely right I think - hang in at the 13mg if that's good for a week at least before trying to go down again. Let the inflammation settle really well and be sure you feel good and then have a go at a half mg reduction to 12.5mg. Then wait at least 2 weeks before trying again. You might find you have a few days of niggles each time you drop the dose - but if you keep the drops as small as possible but also let things stabilise between you should do well.
Good luck!
Eileen
Thanks, Eileen and Pearl,
I'll stay at 13 mg. for another week or two. It seems I'm always in such a hurry to reduce, that I forget the big picture. What you say makes a lot of sense, plus the research you've done supports it.
I'm home today with some kind of stomach bug. I'm a bit worried that it's the prednisone bothering my stomach, but there has been some nasty stuff going around at school.
Also, Mrs. E, I haven't done the ADT that you were kind enough to spell out for me. I'll ask my rheumy about it when I see her in a couple of weeks. I'm one of those folks who takes part of their dose with my evening meal, so that I can get out of bed in the morning. I'll wait until I've been on the 13 mg for a bit anyway.
Hope you're feeling well,
JannieHi again Jannie
Oh, poor you, with a stomach bug - PMR is quite enough to contend with! Like you, my hubby works in a school and they do seem to be a breeding ground for everything don't they! If you don't already eat it, Jannie, do try a live yoghurt as it is excellent for lining the stomach and will help to replace the loss of natural bacteria caused by the "bug". I have taken a small pot of live yoghurt daily with my breakfast to protect my stomach from the steroids as I was unable to tolerate the usual protection drugs prescribed along with the steroids. It's worked....no problems after 4+ years.
BTW, I'm sure MrsE won't mind me adding here as I'm already posting to you: The ADT (alternate day therapy) that Mrs E refers to is not recommended before you reach 10mgs daily and not recommended at all for GCA sufferers. Also, it should not be confused with alternate day dosing where the old dose is taken one day and the new dose the next. You may have already taken these things on board from wherever MrsE posted about ADT to you originally, but it might just be useful for anyone else "looking in" here just now.
Take care and I hope that stomach bug disappears as quickly as it came!
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