REDUCING PRED WITH FRACTURED PELVIS

[hwigston]

I have fractured my pelvis in 3 places - fell off a pavement in Spain. I am due to reduce my pred from 8 to 7 this week-end and asked the Rheumy today whether he thought this was wise. I certainly do not want a flare plus the pain I am in. His reply was yes carry on reducing. Fractures will take up to 12 weeks to heal. What do members of the forum think. I am taking 6 Solpadol a day for the pain.

[polkadotcom]

I think he needs a few lessons; any kind of trauma will upset PMR/GCA anyway and if you add in reducing Pred you will be creating the right conditions for a major flare. If it were me, I'd be inclined to give it several weeks before I even think about reducing the steroid dose and you are hardly on a large amount.

I think I would err on the side of caution.

[PMRpro Ambassador]

I really don't think I would try to reduce. 8mg is about the level where many people struggle anyway - this is where the body is having to start to produce its own corticosteroid, cortisol. Your body is under stress and many doctors feel the combination of stress and a reduction do not combine well. I know several ladies who have had hip or knee replacements and were told under no circumstances to try to reduce just before or after the op.

I don't quite see his argument - it's a non-sequitor. How long the fractures will take to heal has not a lot of bearing on your reduction unless he is one of these "reduce to order irrespective of what is going on". Those of us with PMR know that rarely works.

If I were going to reduce then it would be with my scheme where I only reduce one day at a time at first - that has some chance of success under the circumstances. I doubt going from every day 8mg to every day 7mg will leave you feeling particularly happy - you're in enough pain anyway.

My neighbour did something similar skiing a few years ago - I gather it was a trifle uncomfortable for several weeks. Hope it stops hurting quite so much soon.

[suzieh]

I wouldn't reduce until you start to feel much better. I know from experience reducing won't work unless you feel fine and try and take it easy while reducing. Stress is the thing to avoid - take care and look after yourself, hopefully you will start to feel better soon.

[Celtic PMRGCAuk volunteer]

Oh dear hwigston, I'm, so sorry to hear that. My best friend did the same a few years ago whilst on holiday abroad and after a couple of days in hospital had to make the difficult flight back home.

No, I agree with the others, definitely don't consider reducing at this point - your body has quite enough to cope with as it is.

It took a while but my friend recovered really well, and I do hope you will soon start to feel better.

[hwigston]

many thanks for all your helpful replies. I will certainly take your advice and wait until I am feeling stronger with less pain until I think about reducing.

[Hidden]

Hi hwigston,

Just a thought, did the mechanism of injury fit the damage done to your pelvis? I just wonder if you have had a DEXA scan recently or were they happy that your fall would have led to you fracturing your pelvis in 3 places?

[PMRpro Ambassador in reply to Hidden]

Yes - that thought crossed my mind after finishing my response. Definitely a case for a dexascan I think!

[hwigston]

Dexascan being organised, also MRI scan for possible damage to my spine. I had my last Dexascan 3 years ago when it showed loss of 3% bone loss, which I understand is border-line for osteoporosis. After my last fracture in 2012 Consultant put me on Strontium Ranelate and Adcal-D3, so fractures could be caused by the fall or even greater bone loss. For a normally very active person, no cycling or gardening is so frustrating. Hopefully in a couple of weeks I will be able to go swimming. At present not advised.

[Hidden]

Hi,

That's great that they seem to be on top of it all, not great about the fractures though!

Hope you feel better soon and get back to your activities.

Best wishes