How do depomedrone injections for PMR work? I gue... - PMRGCAuk
How do depomedrone injections for PMR work? I guess they are slow-release somehow. Do you still get morning stiffness with them, I wonder?
I have depo medrone jabs. To begin with a 120 ml jab would only last about two weeks if I was lucky. Now, a year on I'm travelling down the dose well and am on 60 ml, which lasts about 8 weeks.
Everyone responds differently, depending on the symptoms they have and the amount of inflammation found in the blood test you need before each jab. My Rheumy thinks I respond better with a smaller dose given more regularly - other people my get on better with a big dose which can last for a long time.
I have always found the jabs amazing, with the symptoms returning gradually over time. The jabs start working about two hours or so afterwards, but full relief can take 24 hours. I find it is good to take full advantage of the relief while it lasts and make sure I exercise frequently, but don't over-push myself. And the other wonderful thing about the jabs is that you don't get the moon face and weight gain - or any depression. I guess it is because it goes straight to the muscles instead of having to go via the stomach. Pity it is too expensive for the NHS to do it for everyone! The sore backside that stays for about 24 hours after the jab is well worth it for all of that.
I have found that each jab takes away slightly different areas of pain each time. Sometimes my legs still have a residue of discomfort in them, other times my arms/shoulders.
Does that help anniebell? you are the only other person I have heard of on the forum who is on depo-medrone. Are you having to take tablets as well? Do ask more if you need to!!
Good Morning green-girl ..I'm trish 29 and I have been on depo -medrone 150mg for a few months now I'm due to have another one but I'm waiting results of a MRI scan that I had yesterday and have to contact my Rheumatologist on Monday.. I didn't find much relief with the injections and I'm still on 14_14half mg prednisoloneto work along side it.. When I went to my last support meeting the injections were mentioned and I stated that my GP had given the injection in my thigh and not my rear
This is to continue the above post to green_girl and anniebelle..hi again my arthritic fingers made me send the post through to early!! As I stated I was given my injection in my thigh and not my rear and unfortunately I suffered a lot of pain after to my right upper arm ,shoulder and kneck and was unable to sleep for a few nights and had to rest my right arm on a pillow in bed as well to get some comfort.. I am still suffering with this stiffness but I am now on Amitriptilyne10_20mg which has started to make me feel a bit better in myself but doesn't actually get to my pain ,makes me muzzy headed in the mornings but most medication does that. I have been told by my Rheumy that I can go back on Butran Patches10mg for a month if need be but that is to help with the pain in my spine. anniebelle asked about the normal morning stiffness and Yes I still get that until I get a rest during the day..I hope that these injections work for anniebelle and relieves her pain and that this info has been any use to her. I now wait with baited breath after 9 years of PMR to get the results next week of my MRI scan and to be able to walk and get around again unaided..Come On Xmas Fairy( haha) all best wishes to all those PMR/GCA sufferers out there. Trish 29
Thank you both for replying. I haven't started on the depomedrone yet, so I'm trying to get an idea of what to expect. No time to write more now - off out soon. I'll will give more details and ask more questions tonight - thanks again.
Really sorry to hear that you've had all that pain, Trish 29. Fingers crossed for you for next week. You really deserve that Xmas Fairy!
I guess the very different experiences of depomedrone injections described here mean that it's probably foolish of me to be looking for an idea of what to expect in general. But I'll just explain why I asked, particularly about the morning stiffness.
Currently I am taking 15mg per day of oral pred, which I started a week ago. Before that, since being diagnosed (with 'not severe' PMR) in October by my GP, with the help of blood tests, I was trying to keep the pain & stiffness at bay (with some success, esp at first) via Ibuprofen and then Naproxen, while I desperately hunted round for some longer term non-steroidal treatment, as reading about the possible side effects of taking steroids for 2 years or so really scared me.
Anyway, during my essentially fruitless search for any mention of effective non-steroidal treatments, I noticed in the BSR guidelines for PMR that "intramuscular depomedrone may be used in milder cases and may reduce the risk of steroid-related complications", which was backed up by a 1998 controlled trial (admittedly not involving massive numbers of people) that did seem to show fewer side effects with depomedrone.
So when I saw my GP last Friday evening, after a day when the Naproxen didn't seem to be working much at all, we agreed that I would do two weeks of the 15mg per day oral pred while he organised the details of the injection regime etc. The initial oral pred phase would also act as a further diagnostic tool, as per the BSR guidelines.
No doubt I was over-optimistic about how quickly and on what symptoms the oral pred would act, but I was very disappointed still to be having fairly awful morning stiffness, sometimes lasting into the afternoon, even after taking it for four days. (After that I rang my doc and he said I could also take Ibuprofen or Naproxen, which has helped a lot - or maybe it's just that I have now taken the pred for those extra 3 days, who knows.)
But my experience of this last week made me wonder whether taking oral pred daily, in the morning, might make it more likely that it would 'wear off' overnight, letting the morning stiffness come back more readily. And then thinking about a single injection designed to last for several weeks, I wondered if that might mean that the stiffness might only start to return after weeks rather than just day. Wishful thinking perhaps? (Probably just that I don't understand how any of it works in the body ...)
So there's the background to my question - sorry it has involved so many words! Thanks for reading it.
Good morning anniebelle. You certainly have got a lot going on and I will re-read your post later as I have to get ready to go out this morning..I was useless all day yesterday I was exhausted after having my MRI scan and I hurt all day with stiffness .I think this was due to being in the tunnel and having to lie so still for so long, but I count myself lucky that I am now with a good Rheumatologist who listens to me so I hope that he can help me..My pain level is slightly better this morning as I went back on the patches yesterday as well as the Amitriptilyne..I am surprised that you can take the Ibuprofen as my stomach doesn't like it and I've always been warned that it can cause other problems to the stomach .I've never had Napraxon so I don't know what that does. Keep in touch and get plenty of rest with that stiffness .I so look forward to the afternoons when the pain and stiffness eases so as I can feel normal again. take care trish29
Hello Anniebelle and Trish29!
Trish, you sound as if you have loads going on with your body - so sorry to hear of your bad experiences with Depo med and all the dreadful pain (come on Xmas Fairy!!!). There are so many variables. It may be that you have too much going on for the Depo med to help - but that has to be between the Rheumy and you - do ask why you have had so much pain - it doesn't sound 'right' to me - but then I don't have access to your medical record nor am a medic!! I am so sad that you have to go through all of this.......
Anniebelle - well done on all your research whilst feeling horrid. Like you I didn't want to touch steroids with a barge pole. Maybe I'm going to get off lightly with this condition (time alone will tell) - and read with horror about what the tabs do to folk and how awful it is to try to come off them - and thank my lucky stars that my experiences with depo med so far have been mainly positive (again, time alone will tell). The other drugs you are taking to control the pain do not sound good for the tummy. It would be good if you could come off them. I do hope that the jabs work for you as they have for me - stiffness and pain returning slowly over the 'life' of the jab (and me fighting to use every ounce of good the drug gave). But do remember that the drug will act differently on different people - and you may initially at least, need very regular doses. - or you might be one of the lucky ones and need less - fingers very tightly crossed for you.
Green_Girl
Thanks for your comments, Green_girl. I know everyone is different, but can I ask a specific question about your initial experiences with depomedrone, please? You said "To begin with a 120 ml jab would only last about two weeks if I was lucky." So what did you do then? How long was it 'supposed' to last? Anniebelle
Ask away Anniebelle! that's what we are on the forum for.....
There's no time - but the less you have the better, really. Initially it was given more or less on demand, in consultation with the rheumy nurses, who I could phone if I got into big difficulties. It was some time before I could make a jab last a month - and even then the last week was always a huge struggle - but I did this to try to ask my body to behave! eventually I was able to make a jab last two months. It is only recently, as my inflammation levels are stabilising, that I have been able to reduce the dosage - and that is after a year.
How you reduce will depend on how you have reacted to the jabs over time. For instance with me, the rheumy says it seems I do better with more regular jabs - so rather than making a large dose go for three months - I'm better having a smaller dose more frequently. It doesn't matter which way you do it, as the steroid works the same in your body either way. At one time when the jab didn't seem to be working as well, the Rheumy did suggest I take some tablet steroid to supplement it. This was not an option for me, as I do not get on at all well with chemicals going through the stomach - but you may be OK - you just have to discuss as much as you can and question intelligently.
I have also found the rheumy nurses very good. One word of warning - if the PMR has attacked your buttocks/hips, you may find the jabs very painful, as the jabs will go through that muscle. I certainly did not want to sit down after many of them! But I consider this pain just something I have to do to get through life. Be as positive about things as you can be.....
I have assumed that you will have to go to a hospital for the jab? I'm not aware that GPs do it, but it might be different in your area (I'm in London). If it is at the GPs, do ask him/her about how you can contact them and how flexible they are going to be for you. How on earth they can know you don't have 'bad' PMR I don't know!!
Let me know if you need more.......
Hi Green_girl
I don't yet know where /how I'll get my jabs - will learn all of that when I see my GP on Tuesday. Hope it is at the GPs' surgery, as it's just down the road. By the way, I think he said my PMR wasn't too severe purely on the basis of the CRP/ESR readings from my blood tests. I know (now) that some people don't have raised levels of these at all, so it wasn't a really a globally sensible thing for him to have said, was it. However, that was the context in which he did say it.
Thanks for all your info/explanations above, although I don't like the idea of that sore backside!
Not quite sure I understand this, though: "It was some time before I could make a jab last a month - and even then the last week was always a huge struggle - but I did this to try to ask my body to behave! eventually I was able to make a jab last two months." Do you mean that you were using willpower alone to combat the symptoms during these times? I can't imagine myself being strong enough to do that, really. Or do you think your exercise regime has had a big influence on your progress? Were you given advice on exercising or did you work it all out for yourself?
Anniebelle
