Steroid injection verses tablets?

[Pinkladysuki]

I have seen my GP today as I have been in constant pain. it's been suggested that I have a steroid injection once a month as I can't cope with prednisone tablets and they said the side effects from injections are much less. Has anyone else had the injections and if so how did you get on with them. Any advice please. Thank you.

[PMRpro Ambassador]

There are one or two people I know on the forums (not sure if anyone is on this one though) who have been put on the injections because they can't tolerate oral pred. Done well it seems to work quite well but I'd be surprised if it lasts a full month judging by the others. If the doctor is willing to go by symptoms and not the date it is definitely worth a try.

I've heard the claim that the side effects are less - but I don't see how they can be apart from the gastric aspects. My granddaughter was put onto injections because a very opinionated consultant decided she wasn't compliant with her oral pred and that was why her asthma was so bad. She was and it wasn't but the injections did keep her out of hospital for a few months. Her side effects were horrendous (massive weight gain and mood swings) and another doctor took her off them because she thought it wasn't fair to a teenager to put her through it. She was on a very high dose though and most of the side-effects do tend to be worse at high doses.

Good luck - and do tell us how you get on.

[Pinkladysuki in reply to PMRpro]

Thank you for the info, how high was the dose your granddaughter was put on, as my side effects with oral prednisone started at 12.5 mg which is quite a low dose.

[PMRpro Ambassador in reply to Pinkladysuki]

She was on the equivalent of 40mg oral pred I think over a few months.

What side effects do you have at 12.5mg that are so intolerable? I think most of us have some side effects and I gained a lot of weight and suffered muscle wasting with one form of corticosteroid - that didn't happen with others though. My hair went mad and my skin was a bit messy. But nothing was as bad as the 5 years of daily pain and the 6 months of absolute agony before I was put onto 15mg pred.

You don't stay at those doses for more than a few months, the idea is to get the existing inflammation under control and then find the lowest dose that manages the symptoms. There are a couple of slow reduction schemes available on the forums which probably mean you can start to reduce almost straight away, sooner than is normally expected and find the lower maintenance dose quite quickly.

[Green_girl]

I was had jabs and feel very lucky to have been allowed this treatment (tabs made me suicidal). No moon face, no hair loss, no weight gain, no mood swings - the jabs into already painful butt muscles were eye watering at the higher doses though! My first jabs were in the order of 20mg which lasted just under two weeks each. After some months I managed to extend the time until I got to one jab per month. Then we started to titrate the dose, keeping to the monthly appointment. I also had to start on Methotrexate after the first year, due to discovering osteoporosis via DEXA scan. This did enable good titration rate on the jabs. Got off jabs in about 18 months and 'Meths' in about a year.

Please note that I had an excellent and wonderful Rheumy. The point about the good Rheumy is that she listened to me and the blood test results. She worked out that for me it was better to have smaller jabs more frequently and was prepared to go along with this. I also could call the nurses to bring forward or to lengthen the time between jabs. I am, needless to say, so very grateful. I think it is quite unusual to have a department where the consultant works so closely with the nurses and the patient.

The only time I had a flare was after having to see another Rheumy when mine was ill - this one allowed me to suggest a dose that was over 20mgs lower than it should have been. She also said I was better.......as I didn't come off jabs for some time I think she didn't know what she was talking about! Glad I didn't have to see that Rheumy again.

At the higher doses, I did have to be prepared to suffer some days of not feeling good and feeling the pain return, in the week before an appointment had been set. But I had the comfort of knowing if things got too bad I could bring the appointment forward with the agreement of the Rheumy. I suspect that the psychological effect of this 'adult' treatment also helped me to cope and get better well. At one point it was suggested that I combine pills with the jabs to bridge the pain gaps - this was declined by me, due to the awful effect I knew the tabs would bring on.

I think that Rheumys are reluctant to treat with jabs because they are more expensive and also take up hospital time/nurse time. it takes a lot of planning and working closely with the patient to make it all go well.

If you can get a similar relationship going with your Rheumy I hope you would find the jabs really good.

I do hope this treatment works for you too!!

[Pinkladysuki]

Thank you for your reply, it sounds so positive. I know I will have to make some decisions soon. I am waiting for the rheumatologist appointment at the moment. I am sat here now postponing the moment when I have to get off the sofa as it is so painful to push myself up on both my knees and wrists. We had a busy day yesterday and I'm paying for it today.

I really don't want to go back on oral steroids as they gave me so many problems, some of which still remain after nearly 4 weeks off them. I wish I had never taken them in the first place. I had quite a fast taper off them and although I have all the pains, mentally I feel 100% better for not being on them.

I'm taking nothing at the moment and everything is such a struggle. I also had 3 sessions of Bowen Therapy whilst I was on steroids and unfortunately that did nothing at all for me.

Hopefully I will get me appointment soon and see what is suggested.

Good luck to you in your recovery.