I need some advice after a visit to my doctor today.

[Buenavista]

Hi,

After a visit to my doctor today about my trigger fingers, which have become unbearably painful all of the time now and inflamed.

She told me I had two options whilst I wait for an operation. One was to increase my pred to 15mg from 4 1/2mg, which is what I'm on now and come down 2 1/2mg every 5 days until I get back to 4 1/2mg. Or, take liquid anti-inflammatory (enantyum) until I get the pain under control.

Please could someone advise me on this matter, as I really don't know what to do for the best.

Kind regards

Buenavista

[Celtic PMRGCAuk volunteer]

Buenavista

When I had trigger thumb some time ago, one rheumy consultant I mentioned it to at a meeting said that if he'd had his needles with him he would have injected the base of the thumb. It was very painful bending it back through the joint to the right position each time but when my local pharmacist said that both he and his brother had experienced trigger fingers they resolved on their own in about 3 months, I decided to put up with it until mine, too, resolved. Some medics also advise splinting the affected finger/thumb. I was almost off Pred at the time and didn't think there was a link to PMR, especially as non-PMRers also have the problem, so there's no way that I would have considered increasing back up to the starting dose when there were alternative remedies. I guess it depends how much pain you're experiencing, and perhaps others will be along with more helpful advice.

[Buenavista in reply to Celtic]

Hi guys,

Thanks for your replies.

Celtic, we had this conversation before as I recall, about a month ago. I had 6 injections in my hands and not one worked. I have had 2 fingers done, a couple of years ago, in BUPA. But because of my age now, the annual premium was very high, so I came out and now have to have it done on the Spanish N.H. I have 2 on each hand, 3 are just about bearable, but the left hand centre finger is in stage 2 now. It won't bend, it's very hot and painful, but unfortunately the injections do not work on me.

Back to pred, I did not want to do what the Spanish doctor said and go back up, as my 6 weeks on 4 1/2mg is up next week and onto 4mg.

I know I shouldn't take anti-inflam (enantyum), but would it hurt for a week?

Narducci, thanks for your reply and iforget, you sound like me, but it did make me smile.

Thanks for all your help. You are great guys.

Best regards

Buenavista

[iforget]

I get trigger issues way too often and when they don't settle the rheumy injects, cracks and splints them. Personally I would be reluctant to increase the pred by so much because I find it really rough dropping down again but I don't know anything about the oral meds so can't be much help...which makes me wonder why I am even posting such an unhelpful reply (sorry)

[Narducci]

You have my sympathy. I had trigger finger (actually two fingers and thumb) and it

was most uncomfortable. Do you have to wait for NHS to operate?

I was lucky in that I had BUPA cover to get the operation. If you have a choice you

Should go to the best hand surgeon - Mr. Ian Winspur in London - he has operated on musicians hands and is such a nice man.

Personally I do not think increasing your pred will help but I am no doctor. Do get another opinion though.

Hope you manage to get it sorted soon

Best wishes

[Celtic PMRGCAuk volunteer]

Hi again Buenavista

Oh poor you, it does sound as though you're in a far worse situation than me with so many fingers affected, and after hearing what you're going through I now count myself lucky that it was just my thumb! What a shame the injections didn't help.

As far as anti-iinflammatories are concerned, whilst I preferred not to take them alongside Pred due to the risk of a double whammy of possible stomach side effects, and especially as a sufferer of chronic kidney disease, I know that some people do take them (including members of this forum, I believe?). Plus, as you say it would only be for about a week,, then perhaps it's worth trying them for this short time. I do hope they give you some relief and that the eventual surgery sorts it out - good luck!

[Buenavista in reply to Celtic]

Hi Celtic,

Just to let you know, I took your advice and I put a splint on one of the most painful of my fingers and I didn't think it would make any difference, but I was wrong. It alliviates the pain dramatically, so thank you for the telling me about it.

Do you think you could give me some advice on tablet drop down. I am due to go down from 4 1/2mg of pred to 4mg. I can get 2 1/2mg tablets here, that's the lowest dose I can get and I only have a small reserve of 1mg tablets. Could you suggest a program to come down, so I don't run out of 1mg tablets. Is it okay that I take 3 1/2 one day and 4 1/2 the next.

Regards

Buenavista

[Celtic PMRGCAuk volunteer]

Hi Buenavista

So glad to hear the splinting is helping to relieve the pain.

If you aren't able to get hold of another supply of additional 1mg pills, then it would seem that your only option is to try alternate days of 3 1/2 and 4 1/2 as you have suggested. Alternatively, you could taper it slightly more slowly by trying one day at 3 1/2 followed by 2 days at 4 1/2 and repeating in the first week; then if you're feeling comfortable, you could try alternate days the following week.

My experience was to drop in just half mg doses from 5mg, tapering on just one day of the first week, two of the second, etc, so a snail's pace, but it worked. Hopefully you will be fine.

All good wishes

Celtic