Polymyalgia Rheumatica and Supplements: What Was Measured, and What About Prednisone

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease of people aged 50 and over, and the medicinal mushrooms offered to those who live with it are reishi (Ganoderma lucidum, the lingzhi of Chinese medicine), cordyceps and lion’s mane (Hericium erinaceus). The honest answer: no mushroom has been tested in PMR — not in humans and not in animals. The combination with prednisone has never been measured either. What has been measured is what the steroid does to infections, blood sugar and bones.

The kinds of evidence that do exist, from closest to a person to furthest away: on PMR itself — large cohorts of patients on steroids, international treatment guidelines, and five randomized trials of drugs designed to spare steroids; on the drug — volunteer trials that show what a measured interaction with prednisolone and with methylprednisolone looks like; on the mushrooms — human trials on fatigue, blood sugar and immune markers, all in other populations, and enzyme inhibition in rat liver. On the combination “mushroom × prednisone × PMR” — no measurement at all. This page is built around what you are actually asking: what is allowed alongside prednisone, and what was measured on the pain, the stiffness and the fatigue you live with.

Do medicinal mushrooms or supplements help with polymyalgia rheumatica — what exactly was tested?

Nothing. Neither reishi, cordyceps, lion’s mane nor turkey tail has been tested in polymyalgia rheumatica — not in a human trial and not in an animal. Searching “reishi and polymyalgia” on PubMed returns one record: a 2014 patent review that is not a patient study. That is not “evidence it does not work” — it is an absence of measurement.

To understand the gap, it helps to know the disease. According to a 2019 review, PMR is the second most common inflammatory rheumatic disease in older age, after rheumatoid arthritis. According to a 2013 review, it appears from age 50, 2–3 times more often in women than in men, and its hallmark is pain and morning stiffness in the shoulder girdle, and sometimes in the pelvis and neck; the response to steroids is dramatic, and many stop them after 6 months to two years — but according to a 2026 review, more than 50% of patients cannot taper the steroid successfully. In other words, most people reading this page live with prednisone for a long time, and are asking what can be added alongside it.

And the main thing, before anything else: PMR is managed by a physician, and the steroid — its gradual taper, the pace of the taper, going back to it in a flare — is a medical decision. Nothing on this page is a reason to change it. We gathered the wider picture of all the autoimmune diseases on the medicinal mushrooms and autoimmune disease page; here we deal with the narrow intersection: PMR, prednisone, and what the steroid does to the body at 50 and over.

What was measured, in which system — and what came out?

The table sorts your questions by what was measured and in which organism. The rows for mushrooms in PMR are empty. The rows that hold large measurements in PMR patients deal with the steroid itself — infections, blood sugar, bones. And the mushroom rows that do include humans — fatigue, blood sugar, immune markers — were measured in other populations.

Taking prednisone — can you combine it with medicinal mushrooms?

Not measured — 0 interaction studies between prednisone and any of the four mushrooms. What is known: prednisolone, the active form of prednisone, is only very slightly sensitive to drugs that inhibit the enzyme CYP3A4; methylprednisolone (Medrol) is far more sensitive. Reishi inhibited CYP3A — in rat liver microsomes. In humans it was not tested. A question for the pharmacist.

What the market claims. “Reishi is safe with any drug”, or the reverse — “mushrooms disrupt steroids”. Neither sentence rests on a measurement. Searching “reishi and prednisone” returns 0 results; “cordyceps and glucocorticoids in patients” returns 3 — a computer simulation and two reviews, without a single interaction study. The only place we found where prednisone and a mushroom met in humans is a 2004 trial in 121 kidney transplant recipients, in which prednisone was given in both arms as background and the cordyceps preparation replaced a different drug. Nobody measured the prednisone level there.

What was measured on the steroid. For the word “interaction” to mean something, you need a number. Here are three, all with itraconazole — an antifungal drug that strongly inhibits CYP3A4, the main enzyme in drug breakdown. In 2000, in 10 volunteers, itraconazole raised the area under the curve of prednisolone by 24% and its half-life by 29%, and the authors wrote that the interaction is “minor” and “probably of limited clinical significance”. In 2001, in 14 men, itraconazole did not change the pharmacokinetics of prednisolone at all after prednisone 60 mg — but it raised methylprednisolone from 2,773 to 7,011 nanogram·hours per ml. And in 1999, intravenous methylprednisolone — 2.6-fold. In other words: even a very strong inhibitor barely moves prednisone; Medrol, it does.

What is known about reishi. In 2007, a reishi polysaccharide inhibited CYP3A, CYP1A2 and CYP2E1, dose-dependently — in rat liver microsomes. Test-tube concentrations cannot be compared with what reaches the blood when a supplement is swallowed — that was not measured — and MSKCC writes that the clinical relevance “is not known”. There is not a single clinical CYP study in humans for any of the four mushrooms. Why it does not carry over to a person, and what can be known. Putting “inhibition in a rat” together with “a drug that even a strong inhibitor barely moves” gives a less worrying picture for prednisone than for Medrol — but that is inference, not measurement. The wording we can stand behind: not tested in humans — and so a question for the pharmacist, with the name of the steroid (prednisone or Medrol) and the name of the supplement in hand. Not “dangerous to combine”, not “safe to combine”. The full list is on the drug interactions page.

Prednisone raises the risk of infections — and mushrooms “boost immunity”. What was actually measured?

Infection risk on steroids is well measured: among 39,938 patients with PMR and giant cell arteritis, 55.7% had at least one infection over a median of 4.8 years, and risk rose with every 5 mg (adjusted HR 1.13). Mushrooms raised immune markers in healthy people and cancer patients. For reishi, whether that changes infection rates on a steroid was not measured; for cordyceps — one measurement, in kidney transplant recipients on prednisone, not in PMR.

What was measured on the steroid. The large study, from 2019, followed 39,938 patients in 389 family practices in England, 1998–2017. The cumulative risk of any infection was 18.3% in the first year, 54.7% at five years and 76.9% at ten; 26.7% of first infections ended in hospital admission. The most common: lower respiratory tract infections, conjunctivitis and shingles. In adjusted hazard ratios, periods on a steroid compared with periods off it were associated with a 1.48- to 1.70-fold higher risk depending on the type of infection — and the dose–response relationship was found irrespective of patient age, duration of the underlying disease and vaccination status, even at a daily dose below 5 mg. This is an observational study — the association was adjusted for age and disease duration, but it is not a trial — and the direction is consistent and dose-dependent.

What the market claims, and what was measured on the mushrooms. “Mushrooms strengthen the immune system — exactly what someone suppressed by steroids needs.” In a 2023 randomized trial, purified beta-glucan from reishi raised CD3, CD4, CD8 and NK cells versus placebo in healthy adults aged 18–55; in a Cochrane review of cancer patients, CD3 rose by 3.91%, CD4 by 3.05% and CD8 by 2.02%, from studies whose quality was described as “generally not sufficient”. Why it does not carry over automatically. A rise of a few percent in a cell count is a laboratory measure — not fewer cases of pneumonia and not less shingles. We looked for a reishi trial that measured infection rates in adults — and did not find a single one done in patients on steroids. The only measurement we found is in cordyceps: the 2004 trial in 121 kidney transplant recipients on prednisone, in which a cordyceps mycelium preparation replaced azathioprine in one arm (57 patients versus 64) — and a lower infection rate was reported in the cordyceps arm. A single Chinese trial, mycelium rather than fruiting body, transplant recipients rather than PMR patients, and a preparation that replaced an immunosuppressant rather than being added to it — nothing can be drawn from it about reishi, about fruiting body or about PMR. And there is another side: PMR is a disease in which the immune system is overactive, and the steroid is there to restrain it. What happens when the two directions meet — not measured. We looked for a report of an autoimmune flare after any of the four mushrooms — and did not find one; what exists is three patients from 2004 who flared in close proximity to echinacea and spirulina, other immune-stimulating supplements. On the language itself — “modulating” versus “boosting” — we wrote on the medicinal mushrooms and the immune system page.

What can be known today. That the risk of infection on a steroid is real, measured and dose-dependent. The only measurement of a mushroom supplement against that risk — 121 kidney transplant recipients on prednisone, a cordyceps mycelium preparation, 2004: fewer infections were reported; a single Chinese trial, mycelium, not PMR. For reishi, lion’s mane and turkey tail — no measurement. What to ask the doctor. “At my dose, what protection against infections is recommended for me — and is there a reason to avoid something that was measured as raising immune markers?”

Prednisone and blood sugar — can reishi or cordyceps balance it?

Not according to what was measured. In randomized human trials, reishi did not lower HbA1c (−0.10%, not significant) or fasting glucose; in the trial that included a reishi-with-cordyceps arm, the two intervention arms were pooled in the analysis — together, no change (p=0.60). Among PMR patients on steroids, 11 of 222 developed diabetes. There is not a single study that tested a mushroom on blood sugar raised by steroids.

What the market claims. “Prednisone and diabetes” is one of Google’s first completions for “prednisone and…”, and on supplement sites you will find “reishi balances blood sugar” and “cordyceps regulates insulin”. What exactly was measured. A 2015 Cochrane review: reishi at 1.4–3 grams a day, 12–16 weeks, in people with type 2 diabetes — HbA1c fell by only 0.10%, a difference that is not significant. A 2016 randomized trial in 84 participants with diabetes and metabolic syndrome, in three arms — reishi, reishi with cordyceps, and placebo — pooled the two intervention arms in the analysis against placebo, and found no change in HbA1c (p=0.60) or in fasting glucose (p=0.95); there is no separate result for the cordyceps arm. And a 2025 meta-analysis of 17 trials and 971 participants found no significant effect on fasting glucose, with evidence certainty rated “very low”. On cordyceps, MSKCC writes that laboratory studies suggest an additive effect with diabetes drugs, and that the clinical significance “has not been determined”.

What was measured on the steroid. In the 2012 Italian study of 222 PMR patients who took low-dose steroids for an average of 46 months, 11 developed diabetes. It is a retrospective study with no comparison group, so it tells you how many — not how many more than people who did not take them. What can be known today. That someone on a steroid who is worried about blood sugar needs a measurement — not a supplement. And if you also take a diabetes drug, tell your doctor about every supplement, even when the evidence says it does not lower blood sugar. We laid out all the studies on the medicinal mushrooms and blood sugar page.

Prednisone and bones, and a “polymyalgia rheumatica diet” — what was actually measured?

On diet in PMR — 0 trials; in a 2022 British survey, 20 of 197 patients changed their diet on their own, and no non-drug therapy was associated with long-term outcomes. On bones — plenty: of 222 PMR patients on steroids, 55 developed osteoporosis and 31 fragility fractures, mostly after two years. A Cochrane review found that calcium and vitamin D preserved spinal bone density on steroids. On mushrooms and steroid-induced bone loss — 0 in patients. We do not sell calcium or vitamin D.

“Polymyalgia rheumatica nutrition” is Google’s second completion for “polymyalgia” in Hebrew. A PubMed search of PMR with nutrition returns not a single trial — no diet has been tested in this disease. What exists is a survey: in the British PMR Cohort Study, 2022, 197 patients completed a long-term follow-up questionnaire; 81 of them (41.1%) had tried a non-drug therapy — 57 a complementary therapy, 35 exercise, 20 a change of diet — and none of them was associated with long-term outcomes. The authors: use is common “despite the paucity of evidence” supporting it. What has been tested is what the steroid does, and what helps against it. Bones. In the 2012 study, 95 of the 222 patients — 43% — had at least one adverse event, after an average of 31 months of treatment and an average cumulative dose of 3.4 grams: 55 osteoporosis, 31 fractures, 27 hypertension, 11 diabetes and 9 myocardial infarction. Duration of treatment was associated with osteoporosis, and cumulative dose with fractures; most events appeared after two years. A 2008 review in the Lancet wrote that steroid side effects affect more than 50% of patients with PMR and giant cell arteritis.

What was tested against it. A Cochrane review of 5 trials and 274 patients on steroids found that calcium with vitamin D, compared with calcium alone or placebo, preserved bone density: +2.6 at the lumbar spine and +2.5 at the forearm. Fractures, the femoral neck and bone-resorption markers — no significant difference. The authors recommended prophylaxis for everyone starting steroids, given the low toxicity and cost. The 2015 international PMR guidelines — 8 overarching principles and 9 recommendations — include assessing risk factors at the start of treatment and a place for non-drug interventions. We write this because it is what was measured, not to recommend it; the dose and the choice belong with the doctor. And mushrooms: searching mushrooms with steroid-induced osteoporosis in patients returns 0.

Prednisone and alcohol — and what about the alcohol in the extract?

“Prednisone and alcohol” is Google’s first completion for “prednisone and…”. Our extract contains 32% alcohol; a daily serving of about 1.4 ml gives about 0.45 ml of ethanol, or about 0.35 grams — arithmetic on the spec, not a measurement. We write it down so you can bring it to your doctor together with your list of medications.

The arithmetic: 1.4 ml × 32% ≈ 0.45 ml ethanol; times 0.79 grams per ml ≈ 0.35 grams. We did not look for a study of amounts of alcohol like these with prednisone, so we will write nothing about it beyond the arithmetic. What is known about reishi and the liver: in 2023 a 47-year-old man was described who developed acute hepatitis after reishi powder taken with alcohol, and recovered within two weeks; in 2007 two patients were described in whom liver injury appeared a month or two after switching from boiled reishi to powder, and one of them died. The NIH LiverTox database rates reishi D — a “possible rare cause” of liver injury; cordyceps and lion’s mane — E. These are case reports, and they do not concern amounts like those in our serving — the two should not be compared. But anyone taking several regular medications and having liver function tested should make sure the doctor knows about anything new. We went into this further on the medicinal mushrooms and the liver page.

What was measured on the pain, morning stiffness and fatigue you live with?

Not in PMR patients. In 132 neurasthenia patients, fatigue fell 28.3% from baseline on reishi — and 20.1% on placebo. In fibromyalgia, 6 grams of reishi a day improved endurance and flexibility — against carob flour, not placebo; pain was not the endpoint. Mushrooms and morning stiffness — 0 that we found. Reishi and sleep — not one randomized human trial.

Pain and stiffness in the shoulder girdle in the morning are the hallmark of the disease, and alongside them come fatigue and broken sleep. A 2026 review describes IL-6 — an inflammatory protein at the center of PMR — as involved not only in inflammation but also in sleep disturbance, mood, pain and fatigue; that is also why two of the new drugs for the disease block it. Fatigue. The large reishi trial, from 2005: 1,800 mg three times a day, 8 weeks; the feeling of fatigue fell by 28.3% versus 20.1% on placebo, and 51.6% versus 24.6% improved “more than minimally”. The net difference is about 8 percentage points, in neurasthenia — a condition that is not inflammatory. Pain and fitness. In fibromyalgia, 64 women, 6 weeks: aerobic endurance, flexibility and speed improved — against carob flour, a comparison preparation rather than an inert placebo; pain was not measured as an outcome. On chronic pain in general we wrote on the chronic pain page, and on fibromyalgia — on the fibromyalgia page. A Cochrane review of 75 studies and 9,401 participants found that cognitive behavioral therapy reduced chronic pain and distress with a “small or very small” effect — but a measured one.

And sleep. “Prednisone and sleep” is one of Google’s completions, and “reishi for sleep” is the most common completion for “reishi for…” — six out of fifteen. And there is not a single randomized human trial that tested reishi on sleep; the dedicated search returns one record, and it is the fibromyalgia fitness study. We laid it out on the reishi for sleep page. What to ask the doctor. Stiffness and fatigue that come back while the steroid is being tapered can be a sign of a flare — and that is exactly what the doctor needs to hear, before any supplement.

Can reishi actually make symptoms worse?

Measured once, in a different population: in 29 men with Gulf War illness — a condition of chronic fatigue, pain and a neuroinflammatory component — high-dose reishi led to greater symptom severity than placebo (p=0.012). That is not polymyalgia rheumatica and not an autoimmune flare. It is the only trial we found in which symptom severity was higher on reishi than on placebo.

What exactly was measured. A 2021 pseudo-randomized crossover trial: each participant went through 30 days of baseline, 30 days of placebo, 30 days of a low dose and 30 days of a high dose, for three botanicals — reishi, stinging nettle and epimedium. At the low dose reishi did not differ from placebo (p=0.603); at the high dose symptom severity was higher than on placebo. The authors: “reishi may exacerbate symptoms in some sufferers”, and alongside that — “small sample, preliminary results”. High-dose stinging nettle, by comparison, reduced symptoms (p=0.048).

Why it is relevant, and why it is not. Gulf War illness is not PMR; the closer population is rheumatoid arthritis — the 2007 trial, in which reishi was given together with another herb. What is shared here is the experience — persistent fatigue, pain, and an involved immune system — and this is a trial in which reishi was measured on its own against placebo over time. And the lesson: “natural” does not run in one direction, and the dose matters. What can be known: anyone who starts a supplement and feels worse — pain, stiffness, fatigue — stops, writes it down, and tells the doctor. During a steroid taper this matters all the more, because it is hard to tell a supplement from a flare.

“Reishi is anti-inflammatory — maybe I can taper the steroid faster?”

No study supports that. On PMR — 0. The only randomized trial of one of our four mushrooms in an autoimmune rheumatic disease, reishi with a Chinese formula in 65 patients with rheumatoid arthritis, missed its primary endpoint; plasma inflammatory markers did not change, and pain and patient global assessment improved as a secondary outcome — together with another herb. What does spare steroids in PMR has been measured — in drugs, in randomized trials.

What the market claims. “Reishi is nature’s cortisone”, “an anti-inflammatory extract that lets you cut down on medication”. What exactly was measured. The only record that comes up in a search for reishi and polymyalgia is a 2014 review in a patents journal, dealing with the suppression of inflammatory and allergic responses — mechanisms and molecules, not patients. The only human trial of one of our four mushrooms: in 2007, 65 patients with rheumatoid arthritis received 24 weeks of reishi with San Miao San — ACR20 was reached by 15% versus 9.1% on placebo, a non-significant difference. Plasma inflammatory markers, IL-18 among them, did not change; in an ex-vivo experiment the percentage change in IL-18 was lower in the treatment group; pain score and patient global score improved only in the treatment group — a secondary outcome, and in combination with the herbal formula. The authors’ conclusion: “no anti-inflammatory or immunomodulatory effect was demonstrated”. We laid it out on the rheumatoid arthritis page. Why it does not carry over to a person. “Anti-inflammatory” in cells or in a mouse is not a substitute for a steroid in a patient — and in PMR, where more than half struggle to taper, tapering too fast is a recognized cause of a flare.

What can be known today. That the question “what will spare me steroids” is a good question — and that it is being tested seriously, in drugs, in the next chapter. What to ask the doctor. “Am I a candidate for a steroid-sparing drug, and what does it cost me?” — not “which supplement will replace my prednisone”.

“Polymyalgia rheumatica new research” — what has been tested in recent years?

Drugs designed to spare steroids. The IL-6 blockers sarilumab and tocilizumab, the JAK inhibitor baricitinib, and in 2026 also secukinumab, an IL-17A blocker — all in randomized placebo-controlled trials. In every one of them, more patients reached remission or low disease activity on less prednisone. Mushrooms with any of these drugs — 0 studies that we found.

“New research” is Google’s third completion for “polymyalgia” in Hebrew, and “biologic treatment” appears for “polymyalgia treatment”. Here is what was measured. Sarilumab (Kevzara, 2023): 118 patients who flared during a steroid taper — sustained remission at one year in 28% versus 10% on placebo, and a median cumulative prednisone dose of 777 versus 2,044 mg; neutropenia in 15% versus 0%. Tocilizumab (Actemra, 2022): 101 steroid-dependent patients with a mean age of 67.2 — the target was reached by 67.3% versus 31.4%, and 49.0% versus 19.6% stopped prednisone; the most common side effect was infection, 46.9% versus 39.2%. In a smaller trial of 36 newly diagnosed patients, steroid-free remission in 63.2% versus 11.8%. Baricitinib (Olumiant, 2025): 34 newly diagnosed patients — 78% versus 13% reached low disease activity without oral steroids. Secukinumab (Cosentyx, 2026): 381 patients — sustained remission in 41.2% and 40.6% on the two doses versus 20.4%. And who paid: the sarilumab trial was funded by Sanofi and Regeneron, the baricitinib trial by CHU Brest and Eli Lilly, and the secukinumab trial by Novartis — in the three new-drug trials whose abstracts state the funding, the manufacturer funded or supported it; the tocilizumab abstracts do not state the funding. And methotrexate, the long-established drug, is mentioned as steroid-sparing in patients with a refractory course.

And the mushrooms. On IL-6 blockers and JAK inhibitors — 0 studies with any of the four mushrooms. JAK inhibitors are partly broken down by CYP3A4, and the link to the inhibition reishi showed in rat liver is purely theoretical. Anyone switching to one of these drugs, or receiving methotrexate — on methotrexate and mushrooms we wrote on the rheumatoid arthritis page — asks the pharmacist before any supplement.

A new headache or a vision problem — why does it matter so much in PMR?

Because PMR is linked to giant cell arteritis (GCA) more than chance explains. A 2008 Lancet review says the two diseases “frequently occur together”, and lists among GCA’s signs vision loss, headache, scalp tenderness and jaw pain while chewing. Mushrooms and GCA — 0 studies that we found. Not a matter for a supplement — a matter for a doctor, fast.

A 2013 review puts it explicitly: PMR “is associated with giant cell arteritis more often than expected by chance alone”. In GCA the inflammation affects the aorta and its branches, and the 2008 review also lists stroke among the complications. We mention it here because anyone looking for supplements for PMR needs to know which new symptom must not be put down to a supplement, to fatigue or to age. What to ask the doctor. “Which signs should bring me to you immediately?” — and write the answer down.

What we actually measure in our bottle

After a page that says “not measured” in almost every row, you deserve to know what was measured — and about what exactly. We grow the mushrooms ourselves, on a farm in the Galilee: fresh fruiting body, not mycelium grown on grain and not imported powder whose history nobody can know. The mushroom goes from harvest straight to extraction, with no drying step in between; as far as we know, we are among the few in the world who work this way. The extraction is triple, and its alcohol stage runs for 7 weeks. The extraction ratio of our reishi is 1:3, and of our cordyceps 1:2.5, on a fresh-mushroom basis. Alcohol in the finished extract: 32% — the figure we did the arithmetic on in the alcohol chapter, and one worth bringing to your doctor together with your list of medications.

And the numbers are not ours to set. We sent the finished extracts for testing at TÜV Austria, and what came back is the beta-glucan percentage on a dry-matter basis — and alongside it alpha-glucan, meaning starch, which was not detected in any of them. Alpha-glucan not detected is the chemical proof that there is no grain in the bottle. To understand why that matters, it helps to know the market’s three-step ladder: mycelium grown on grain, where beta-glucan is usually below 7% and most of the weight is starch; imported dried fruiting body, whose quality depends on who dried it and when; and fresh fruiting body from the farm, which is what we do. On a page that has dealt so much with the immune system, it should also be said: this number describes what is in the bottle, not what it does in the body. Why beta-glucan and not “total polysaccharides” — we explained separately.

All our tests are public, and anyone who wants to read the report themselves will find our explanation of how to read a COA. Kosher certification — Mateh Yehuda Rabbinate, Rabbi Gad Atias. That is what we know how to measure and prove about what is in the bottle. What it will do for polymyalgia rheumatica was not measured — so it is not written.

What this page does not say — and what we do not claim

We do not claim that reishi, cordyceps, lion’s mane or turkey tail improve polymyalgia rheumatica, ease stiffness or pain, reduce inflammation, balance blood sugar, protect the bones or lower the risk of infections — none of these has been measured in PMR; on infections in people taking prednisone there is one trial, in kidney transplant recipients and with cordyceps mycelium, and we draw nothing from it about PMR or about our extracts. We do not claim the opposite either — that the mushrooms make PMR worse: the Gulf War illness trial is a different population. We do not claim that combining them with prednisone, Medrol, methotrexate or the new biologic drugs is safe — it was not measured; nor that it is dangerous — that was not measured either. The interaction trials we cited were done with an antifungal drug, not with medicinal mushrooms. We do not claim that calcium and vitamin D suit everyone — they were measured in trials, the dose belongs with the doctor, and we do not sell them. And we do not deal here with disability benefits, disability ratings or entitlements — we have no expertise in those and no sources on them. What we do say: PMR is managed by a physician, and tapering the steroid is a medical process. Do not stop, reduce or change prednisone on your own, and anyone adding any supplement — including ours — tells the doctor before, not after. Under DSHEA, a dietary supplement may not claim to diagnose, treat, cure or prevent any disease. We sell mushroom extracts, and we are telling you explicitly not to buy them for polymyalgia rheumatica.

The bottom line

There is no measurement at all of medicinal mushrooms in polymyalgia rheumatica — not in humans and not in animals — and not a single study of the combination with prednisone. What has been measured, and at scale, is what the steroid does: infections that rise with every 5 mg, diabetes, osteoporosis and fractures. And against each of these, what the market offers in the mushrooms’ name does not hold up: they raised immune markers, and on infections there is one measurement — cordyceps mycelium in 121 kidney transplant recipients on prednisone, not PMR and not reishi; they did not lower blood sugar in randomized trials, and on bones there is nothing on them in patients. What spares steroids in PMR has been tested — in drugs. And there is one trial in which symptom severity was higher on high-dose reishi than on placebo. If someone sells you a mushroom “for polymyalgia” — send them this page, and talk to your doctor.

Frequently asked questions

Does reishi help with polymyalgia rheumatica?

Not tested. There is not a single study of reishi, or of any other medicinal mushroom, in PMR patients — in humans or in animals. The only record that comes up in a search is a patent review. The only randomized trial of one of our four mushrooms in an autoimmune rheumatic disease — reishi in rheumatoid arthritis — missed its primary endpoint, 15% versus 9.1% on placebo.

Can I take medicinal mushrooms with prednisone?

The combination has not been measured — 0 studies. Prednisolone, the active form of prednisone, is only slightly sensitive to drugs that inhibit the enzyme CYP3A4: a strong inhibitor raised it by only 24%. Reishi inhibited this enzyme in rat liver, not in humans. It is a question for the pharmacist, with the name of the drug and the name of the supplement in hand — not a decision to make alone.

And what about Medrol?

Medrol (methylprednisolone) is far more sensitive than prednisone to CYP3A4 inhibition: in volunteers, a strong inhibitor raised its level from 2,773 to 7,011 nanogram·hours per ml. Mushrooms with Medrol — 0 studies, and reishi inhibited this enzyme family only in rat liver. If you are on Medrol, the question for the pharmacist matters even more.

Mushrooms “boost immunity” — will that protect me from infections while I am on steroids?

Not measured for reishi. In healthy adults, purified beta-glucan from reishi raised CD3, CD4, CD8 and NK cells; but no reishi trial has tested whether that means fewer infections in people taking steroids. For cordyceps — one trial in kidney transplant recipients on prednisone (mycelium, 2004) reported fewer infections, not in PMR. What was measured is the risk itself: 18.3% in the first year among patients with PMR and giant cell arteritis, rising with the dose. Ask your doctor which protection is recommended for you.

Prednisone raises my blood sugar — will reishi or cordyceps help?

According to randomized human trials — no. Reishi did not lower HbA1c (−0.10%, not significant), and in the trial that included a reishi-with-cordyceps arm, the two intervention arms were pooled in the analysis — together they changed neither HbA1c nor fasting glucose. Of 222 PMR patients on steroids, 11 developed diabetes. Blood sugar that rises on steroids needs measurement and a doctor, not a supplement.

What should I eat with polymyalgia rheumatica?

There is not a single trial of diet in PMR; in a 2022 British survey, 20 of 197 patients changed their diet on their own — with no association to long-term outcome. What was tested is calcium and vitamin D in people taking steroids: 5 trials and 274 patients, spinal bone density was preserved (+2.6), fractures — no significant difference. We do not sell them; the doctor sets the dose.

Can reishi help with fatigue or sleep?

In PMR patients — not measured. In neurasthenia, 132 patients, fatigue fell by 28.3% on reishi versus 20.1% on placebo — a difference of about 8 points. On sleep there is not a single randomized trial. And in Gulf War illness, at the high dose symptom severity was higher than on placebo; at the low dose — no change.

What is new in polymyalgia rheumatica research?

Drugs that spare steroids. Sarilumab: remission at one year in 28% versus 10% on placebo. Tocilizumab: 49.0% versus 19.6% stopped prednisone. Baricitinib: 78% versus 13% without oral steroids. Secukinumab, 2026: 41.2% versus 20.4%. With mushrooms — not one of them has been tested.

Scientific sources (peer-reviewed)

• PMR at age 50 and over; associated with GCA “more often than expected by chance”; women 2–3 times more often; pain and morning stiffness in the shoulder girdle; many stop steroids after 6 months to two years — Pipitone N, Salvarani C. European Journal of Internal Medicine, 2013. View on PubMed
• PMR and GCA “frequently occur together”; signs of GCA — loss of vision, headache, scalp tenderness, jaw pain; steroid side effects in more than 50% of patients — Salvarani C, et al. Lancet, 2008. View on PubMed
• The second most common inflammatory rheumatic disease in older age, after RA; methotrexate as steroid-sparing in a refractory course — Camellino D, et al. Drugs & Aging, 2019. View on PubMed
• EULAR/ACR recommendations for managing PMR: 8 overarching principles and 9 recommendations, including risk-factor assessment and non-drug interventions — Dejaco C, et al. Annals of the Rheumatic Diseases, 2015. View on PubMed
• More than 50% of PMR patients fail to taper steroids; IL-6 is involved in sleep, mood, pain and fatigue — Choy EH, et al. Annals of the Rheumatic Diseases, 2026. View on PubMed
• 222 PMR patients on low-dose steroids, average 46 months: 43% — an adverse event; 55 osteoporosis, 31 fractures, 27 hypertension, 11 diabetes, 9 myocardial infarction; mostly after two years. Retrospective — Mazzantini M, et al. The Journal of Rheumatology, 2012. View on PubMed
• 39,938 PMR/GCA patients in England: cumulative infection 18.3% at one year, 54.7% at five, 76.9% at ten; HR 1.13 per 5 mg; dose dependence even below 5 mg. Observational — Wu J, et al. CMAJ, 2019. View on PubMed
• Cochrane, calcium and vitamin D with steroids: 5 trials, 274 patients; lumbar density +2.6, radial +2.5; fractures — no significant difference — Homik J, et al. Cochrane Database of Systematic Reviews, 2000. View on PubMed
• 10 volunteers: itraconazole raised prednisolone by 24% (AUC) — “limited clinical significance”; prednisolone less sensitive than methylprednisolone — Varis T, et al. European Journal of Clinical Pharmacology, 2000. View on PubMed
• 14 men: itraconazole did not change prednisolone after prednisone 60 mg; methylprednisolone — AUC from 2,773 to 7,011 — Lebrun-Vignes B, et al. British Journal of Clinical Pharmacology, 2001. View on PubMed
• 9 volunteers: intravenous methylprednisolone + itraconazole — AUC 2.6-fold — Varis T, et al. Pharmacology & Toxicology, 1999. View on PubMed
• A reishi polysaccharide inhibited CYP2E1, CYP1A2 and CYP3A dose-dependently in rat liver microsomes — Wang X, et al. Biological & Pharmaceutical Bulletin, 2007. View on PubMed
• 121 kidney transplant recipients, prednisone as background in both arms: a cordyceps mycelium preparation (57) versus azathioprine (64) — a lower infection rate was reported in the cordyceps arm; no interaction measured — Sun M, et al. Chinese Journal of Integrated Traditional and Western Medicine, 2004. View on PubMed
• Sarilumab, 118 patients in relapse: remission at one year 28% versus 10%; cumulative prednisone 777 versus 2,044 mg; neutropenia 15% versus 0% — Spiera RF, et al. The New England Journal of Medicine, 2023. View on PubMed
• Tocilizumab, 101 patients, mean age 67.2: target 67.3% versus 31.4%; off prednisone 49.0% versus 19.6%; infections 46.9% versus 39.2% — Devauchelle-Pensec V, et al. JAMA, 2022. View on PubMed
• PMR-SPARE: tocilizumab in 36 newly diagnosed patients — steroid-free remission 63.2% versus 11.8% — Bonelli M, et al. Annals of the Rheumatic Diseases, 2022. View on PubMed
• Secukinumab, 381 patients: sustained remission 41.2% and 40.6% versus 20.4%. Funding: Novartis — Stone JH, et al. The New England Journal of Medicine, 2026. View on PubMed
• Baricitinib, 34 newly diagnosed patients: low disease activity without oral steroids at week 12 — 78% versus 13% — Saraux A, et al. The Lancet Rheumatology, 2025. View on PubMed
• The only autoimmune trial of one of our four mushrooms: 65 RA patients, reishi + San Miao San, 24 weeks — ACR20 15% versus 9.1%, not significant; plasma inflammatory markers unchanged, ex-vivo IL-18 lower; pain and patient global — secondary improvement — Li EK, et al. Arthritis and Rheumatism, 2007. View on PubMed
• The only record in a search for reishi and polymyalgia: a review of patents and mechanisms, not a study of patients — Bhardwaj N, et al. Recent Patents on Inflammation & Allergy Drug Discovery, 2014. View on PubMed
• Purified beta-glucan from reishi in healthy adults aged 18–55, 84 days: rise in CD3, CD4, CD8 and NK; a significant difference in IgA, direction not stated in the abstract — Chen SN, et al. Foods, 2023. View on PubMed
• Cochrane, reishi in cancer patients: CD3 +3.91%, CD4 +3.05%, CD8 +2.02%; quality “generally not sufficient” — Jin X, et al. Cochrane Database of Systematic Reviews, 2016. View on PubMed
• Three patients — pemphigus and dermatomyositis — who flared in close proximity to echinacea and spirulina (not mushrooms) — Lee AN, Werth VP. Archives of Dermatology, 2004. View on PubMed
• Cochrane, reishi for cardiovascular risk factors: HbA1c −0.10%, not significant; adverse events RR 1.67, not significant — Klupp NL, et al. Cochrane Database of Systematic Reviews, 2015. View on PubMed
• 84 participants, reishi / reishi + cordyceps / placebo, 16 weeks: HbA1c (p=0.60) and fasting glucose (p=0.95) unchanged — Klupp NL, et al. Scientific Reports, 2016. View on PubMed
• Meta-analysis, 17 trials and 971 participants: no significant effect on fasting glucose; certainty “very low” — Jafari A, et al. Food Science & Nutrition, 2025. View on PubMed
• A 47-year-old man, acute hepatitis after reishi powder with alcohol; recovery within two weeks — Guedikian R, et al. Cureus, 2023. View on PubMed
• Two patients: liver injury after switching from boiled reishi to powder; one fatal — Wanmuang H, et al. Journal of the Medical Association of Thailand, 2007. View on PubMed
• 132 neurasthenia patients, 1,800 mg ×3 a day, 8 weeks: fatigue −28.3% versus −20.1% on placebo; “more than minimal improvement” 51.6% versus 24.6% — Tang W, et al. Journal of Medicinal Food, 2005. View on PubMed
• 64 women with fibromyalgia, 6 grams of reishi a day, 6 weeks, versus carob flour (not placebo): endurance, flexibility and speed improved — Collado Mateo D, et al. Nutrición Hospitalaria, 2015. View on PubMed
• 29 men with Gulf War illness, pseudo-randomized crossover: low-dose reishi — same as placebo (p=0.603); high dose — greater severity (p=0.012). “Small sample, preliminary” — Younger J, et al. International Journal of Environmental Research and Public Health, 2021. View on PubMed
• Cochrane, psychological therapies for chronic pain: 75 studies, 9,401 participants; effect “small or very small” — Williams ACC, et al. Cochrane Database of Systematic Reviews, 2020. View on PubMed
• British PMR cohort, 197 patients in a long-term follow-up questionnaire: 81 (41.1%) tried a non-drug therapy — 57 a complementary therapy, 35 exercise, 20 a change of diet; none was associated with long-term outcomes — Weddell J, et al. Rheumatology International, 2022. View on PubMed

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This page is educational and does not constitute medical advice, diagnosis or a substitute for professional care. Medicinal mushroom extracts are dietary supplements, not drugs, and are not intended to treat polymyalgia rheumatica or any other medical condition. Polymyalgia rheumatica requires medical diagnosis and follow-up. Do not stop, reduce or change the dose of prednisone, methylprednisolone, methotrexate, a biologic drug or any other medication without your physician’s guidance. A new headache, a vision disturbance or jaw pain while chewing requires immediate medical attention. The page describes what published trials and case reports recorded — and what was not recorded; it is not a prediction of what any individual will experience, and it is not a recommendation to start, stop or combine any supplement with any medication — those decisions belong with your physician or pharmacist, especially if you take regular medication, or have diabetes, osteoporosis, planned surgery, liver or kidney disease, or any existing medical condition. *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.*