PMR and Antibiotics for Dental Pain

[josvanloo]

Hi - I have PMR since March 15 and I am experiencing a new problem. I had complex dental surgery done – 2 inflamed teeth – but only one could be fixed last Friday. The dentist anticipated lots of pain – and indeed paracetamols were not enough, I could not get any sleep. So Saturday morning I started taking the antibiotics (AMOXiLLIN). This did not reduce the terrible pain (and I had these pills before when I developed a tooth ache 1 days before going on holiday in Africa and then they worked immediately). Then I noticed when performing my most difficult PMR exercise of the day (pushing myself out of the bath tub) that I could nearly jump out. All my pilates exercises for my arms / shoulders (my PMR is mainly located in the upper arms) caused no pain but went very smoothly. So I am suspecting that the antibiotics attack the PMR – not the dental pain? Is this possible? Should I be asking for specific painkillers / remedies that help my teeth – not the PMR – if they exist. (the pain in my teeth is a factor X worse than my PMR pain ). I called NHS direct and they gave me telephone numbers of emergency dentists, but after my experience last Friday and I not sure if they would have the PMR background – so that is why am asking this friendly panel if anybody experienced something similar and has recommendations. Thank you

[PMRpro Ambassador]

Someone mentioned this effect with antibiotics on another forum recently - plus the fact that their doctors weren't interested! I also wrote there about a friend in Hungary who developed PMR that required very high doses of pred to manage. Her husband is a doctor and, together with her rheumatologists, she was trialed on long term antibiotics which achieved remission and she was able to stop them too.

PMR is not the disease - it is the name given to the set of symptoms and there are several causes. It isn't out of the question that yours may be due to a bacterial infection - were you checked for Lyme disease for example? Antibiotics also have an antiinflammatory effect - maybe it is enough to give such a good result.

As for painkillers - paracetamol is fairly useless and antibiotics are doing something else, they were probably attacking the cause the last time, very likely an infection, they have no painkilling properties per se. To get anything really effective that you can take alongside pred you will probably need a prescription - no NSAIDs, they are contraindicated with pred.

[josvanloo in reply to PMRpro]

Thank you for your reply - I was told to take Ibuprofen by the Lancashire dental care emergency hotline 1 hour ago . This is an NSAID I believe ? ( I told the person 3 times I took steroids) . Got clove oil from the pharmacy -this will have to do until dentist opens again tomorrow morning .

[PMRpro Ambassador in reply to josvanloo]

Yes, an NSAID! It is likely that a single dose wouldn't do much harm and I used to do that very occasionally. But a friend was told to take ibuprofen for her PMR (a generally useless GP practice as it happened) and she was in A&E after 3 doses with a gastric bleed - and that was without pred!

Can you get cocodamol at all without prescription these days? I've just looked so I'll answer that: you can get low dose cocodamol from the pharmacy but higher dose codeine content has to be prescribed. That is codeine and paracetamol which is OK with pred and might work better as there is a bit more on top of the paracetamol. You can't increase the dose though as there is alimit to how much paracetamol is safe to take.

I assume you asked the pharmacist if there is anything else?

[lesley2015 in reply to PMRpro]

My Rheumey told be to use ibuprofen not paracetamol (still on over 20mgs preds), because it was an anti-inflammatory, I use paracetamol because I trust what on this forum more - which isn't really good is it?? Cocodamol upsets my tummy.

[PMRpro Ambassador in reply to lesley2015]

Your RHEUMY told you to use ibuprofen at the same time as 20mg pred? Flying in the face of the guidelines in the rest of the world. If 20mg pred wasn't doing it as an antiinflammatory I doubt a bit of ibuprofen would make much difference!

I don't like cocodamol either - and paracetamol does not a lot, works for the odd headache I suppose.

[lesley2015 in reply to PMRpro]

Yes he was saying if I had pain when tapering down I could use some pain relief. I suggested paracetamol and he said no use ibruprofen it better as it is anti inflam. But you are right when needed paracetamol hadn't done much to help!

[Meg1711b in reply to PMRpro]

Very interesting. I took antibiotics back in October for a UTI, and definitely felt they improved my PMR as well.

[Hidden]

GCA/PMC are probably associated with chronic infection. Whether rheumy world would like to admit it or not. Do some of them actually admit? That's just my impression. Having said that I also notice whenever I use antibiotics, I flare whilst on immunosuppression. Not sure why. GCA is traditionally a disease meant for older people whose immune system had gone though decay as anything else does in our advancing age (unable to clear infections). I saw somewhere research is directed towards finding a better therapy to deal with infection other than antibiotics. In the meantime, we ask ourselves a few questions.. I know a lady who was diagnosed with G C A and was put on pred, she said it didn't help. She thought she was misdiagnosed. No, she still had GCA (biopsy proven).

[josvanloo]

Thanks to everybody for their replies and maybe to close this post. After 4 days on antibiotics I went back to the dentist. The improvements for my teeth were marginal so we will expand the course to seen days - then tooth will go or not. The PMR ... well at the moment it feels as if it is completely gone. Hope this helps somebody in the medical world.