PMR Flare

[jaydy]

Please what does a PMR flare usually consist of. Have reached a stage where I do not know whether I am really confused about symptons.

[PMRpro Ambassador]

A flare is a return of the symptoms that led to you being diagnosed as having PMR. It may be just one or some of them or a complete return to the state you were in pre-pred.

A flare can be caused in two ways. PMR symptoms are due to an underlying autoimmune disorder that causes your immune system to be unable to recognise your body as "self". As a result it attacks tissues in your body and causes inflammation. The activity of this underlying autoimmune disorder can remain steady and the symptoms are much the same all the time or it may wax and wane - so that you have good patches when it is quiet and bad ones when the activity is increased and the symptoms worse because the tissue damage is greater.

The pred reduces the inflammation - it does nothing to change the autoimmune part. So you can have a flare because the underlying activity has increased and the damage being done isn't dealt with by the same dose you have been on until now. The more active it is - the worse the symptoms become.

Or you can have a flare because you are trying to reduce the dose of pred you are taking and you take it too low to cover up the inflammation - it doesn't soothe it and there's some left over and some symptoms return. The lower you take the dose the less is dealt with - and the worse the symptoms can be.

By reducing very slowly and in very small steps you will find that borderline dose more accurately - but it also means that at some point the activity of the illness may increase and you may need a higher dose of pred again. Like with, say, acne - when it is mild you don't need so much make up to cover it, when it flares up you need more.

If you reduce in big steps you may have 2 problems - you might overshoot and miss the "right" dose and have a flare but you might also find your body protesting at the removal of the dose it has become used to. Then you develop something often called "steroid withdrawal rheumatism". It starts quickly after going to a lower dose and then improves.

The pain that comes because the dose is too low may not start for a few days or more and then steadily increases - then you need to go back to a higher dose.

[jaydy in reply to PMRpro]

Thank-you for the comprehensive explanation. It is so difficult to differentiate between pre-existing muscular skeletal problems and problems caused by PMR (or pred reduction)

[PMRpro Ambassador in reply to jaydy]

You also have to bear in mind that pre-existing musculoskeletal problems COULD be associated with the PMR. While a lot of doctors will tell you that PMR happens overnight - no, it doesn't necessarily. Often when you look back you can identify things that were there for months, even years, beforehand. They may have come and gone, responded to some extent to other forms of therapy, but they may still be associated.

And also totally random things - like finding it difficult to walk barefoot, your balance being "off", being unable to hold something bigger - I couldn't hold a 1.5 litre bottle of water but I could manage a wine bottle because it was so much smaller to get my hand around. (No sarky comments from those who know me now )

[DorsetLady PMRGCAuk volunteer]

Ditto to PMRPro's response! Nuff said really. Saved me typing it!