Brief Answer:
Decortin taper

Detailed Answer:
There is a mismatch of the age mentioned in the stem above. In one place it says 32 while in the body of the question it says 58.

Regardless, the answer really does not change.

There is no fixed and established standard way of tapering decortin that is followed globally in a uniform manner.

So you will be best served by seeing an endocrinologist in-person to assist you with this.

This is what I typically do for my patients:

Take 4.5 mg/day for 3 weeks. (This can be achieved by alternating daily doses, eg, 5 mg on day one and 4 mg on day two)

Then 4 mg /day for 3 weeks
Then 3.5 mg /day for 3 weeks

Then 3 mg /day for 3 weeks

Then 2.5 mg /day for 3 weeks

Then 2 mg /day for 3 weeks

Then 1.5 mg /day for 3 weeks

Then 1 mg /day for 3 weeks

Then 0.5 mg /day for 3 weeks

then stop it all together.

This regimen will generally prevent symptoms of cortisol deficiency. At some point, however, many patients with rheumatic diseases complain of recurrent symptoms of the underlying disease. In this setting it may be difficult to distinguish between mild symptoms of glucocorticoid withdrawal (ie, joint and muscle pain = 'pseudorheumatism') or re-emergence of your polyarthritis

If the symptoms are not major, we try to wait 7 to 10 days, and use a nonsteroidal antiinflammatory drug (NSAID) or other analgesic. Resolution of symptoms during this period of time suggests pseudorheumatism. If the symptoms do not subside within this time frame, we increase the prednisone dose by 10 to 15 percent (to the next convenient mg tablet regimen) and maintain that dose for two to four weeks. If the symptoms resolve, the above tapering regimen can be resumed, using two to four weeks between dose reductions rather than one to two weeks.

Should this modest increase in dose not be sufficient to relieve symptoms, we double the prednisone dose. The disease flare is allowed to subside and the taper is reintroduced at a slower rate (eg, once monthly).

It should also be noted that the dose change is inappropriate if life-threatening flares occur (as can occur situations like lupus affecting kidneys but not so much with your polyarthritis). In these settings, a return to the original, highest dose of steroids should be started. Tapering which is slowed in rate or dose can be undertaken after the flare subsides, but specific guidelines become both complex in the latter situations. That is why a hormone expert such as an endocrinologist can guide treatment based on examination and possible use of tests such as the Short Synacthen test

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