Have been on Mestinon daily for at least the last 4 years from 240 - 360 mg per day just finished Cyclophade treatment . Have almost full remission ( for next 9 months ) except knees, doctor says maybe rheumatoid arthritis, going for checks next month. As i am of Prednisalone which masks RA in blood tests. The knees have no pain for about a day a week. I have tried keeping them warm, resting for up to 2 days, doesn't seem to be a formula. The only thing certain is after an expedition ( shopping, IVIG infusions, doctors) it is always bad the next day.