Atypical PMR - was responding to steroids, not now

[missrat]

Four years ago I was diagnosed with PMR with an ESR of 20. All settled with steroids, which were tailed off by two years.

Earlier this year I had similar, but more severe symptoms, which responded within a few days to 15mg prednisolone, but my ESR and CRP were normal. Last week I saw a rheumatologist and had more blood tests and x-rays. I see her again on 26th July. I am allowed to reduce my steroids myself.

When I decreased to 10mg the pain returned, and I was allowed to increase it to 12.5mg, then 15mg, but I still have mild pain. However, I am sure that the steroids are worsening my depression. I saw my GP yesterday and have reduced to 12.5mg, and hope to reduce to 10mg in 1-2 weeks.

Has anyone else experienced this? Do you think it is PMR? The only alternative I can think of is fibromyalgia. Unfortunately I have very little response to analgesics.

[polkadotcom]

The fact that your symptoms responded to Prednisolone would suggest that you have a return of PMR. Fibromyalgia does not respond to steroids at all, nor basic painkillers as a rule anyway.

I have both PMR and GCA and I have never had raised inflammation markers.

Depression is listed as a side effect of Pred, so perhaps you could talk to your rheumatologist when you see her. It might be suggested that you get down to 10mg again and stay at that dose for a fairly long time to control the symptoms. That dose is close to the amount of cortisol you would make naturally and any side effects should be greatly minimised.

[missrat]

I've had long-term depression anyway, and it seems that the steroids make it much worse.