Flare

[Abigail1]

Had two glasses of wine diluted with water last night, feel awful today real flare up, could this have been the alcohol or just a coincidence ?x

[piglette]

I happily drink wine occassionally. I cannot see why you should have a flare up unless you had a real whoopee time as well!

[HeronNS]

I went through a frustrating spell of not being able to drink even the very modest amount that I like ( single beer or a single small glass of wine or a tiny glass of sherry).  However lately I've been able to have the occasional glass of something.  Drank a small bottle of organic apple cider the other day and was fine.   I wonder if it is pred dose related?  I'm also able to tolerate small helpings of wheat-based foods again (like a single slice of bread or a decadent cupcake).  🍺🍞

[markbenjamin57]

Hello Abigail1.  If it helps: for me at least, alcohol (or not) doesn't make a difference to flares - it's probably a red herring.  If anything, a modest intake of wine  in the evening helps me to relax and sleep better. 

Having said that, I defer to others here who have more experience / knowledge of these things. 

Best wishes, and bottoms up!

Mark B

[bowler]

I think it depends on how much Pred you are taking,?  I seem to think that alcohol isn't good if you are on a high dose.

[PMRpro Ambassador]

Everyone is different - so it may be. Wine has no effect on me except as Mark has said - the vasodilation helps. Personally I'd put it down to coincidence - and there is only one way to investigate that, repeat the experiment!

It doesn't matter how much water you add, the alcohol is the same so my preference would always be the wine in one glass and the water in another! 

[DorsetLady PMRGCAuk volunteer]

Hi Abigail,

Think it's probably a coincidence, although you don't say what level of Pred you are on, which could have a bearing. Must admit I laid off all alcohol when I first started on Pred, though it wise at 80mg! 

However, on lower doses I thought I'd give it a go, and never had a problem, although I cannot drink a heavy red anymore, that may just be a change in taste though. Lighter reds, whites, rose and especially champagne (when someone else is buying!) are no problem. 🍾 🍸

As others have said the only way to find out is to try again, maybe just one this time...and don't dilute, have another glass of water on the side! 

Life with PMR is such a drag at times, we all need something to cheer us up occasionally. 

Cheers. 

[PMRpro Ambassador in reply to DorsetLady]

"I cannot drink a heavy red anymore"

That is a very common phenomenon - you are definitely not alone! I'm so glad I live in a region where the best reds are pretty light.

I'm a Sekt and prosecco girl - but I gather the UK has discovered prosecco too and have their eyes on Germanic fizz in case Italy runs short...

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

With you on that one - yet again. Very partial to a bit of fizz........ Unfortunately - expensive tastes without the budget to go with it! Ce la vie! 

[PMRpro Ambassador in reply to DorsetLady]

Perfectly acceptable generic prosecco here is about £3 when on "special", Sekt tends to be a bit more but not a lot. There is a particularly delightful low alcohol Italian pink fizz that is just about £1.50 on special offer...

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Probably just as well I don't live there then -might have to worry about liver as well as everything else! 

[PMRpro Ambassador in reply to DorsetLady]

You know all this epidemiological stuff about bacon/red meat/alcohol and anything worth eating or drinking "causes" cancer? 

Here the first glass of wine for our generation and above is any time after breakfast. The food is heavy on fattish bacon, sausages and cold processed meats of various sorts, pork and beef. There is the occasional young death, more often than not from falling off a road or a mountain and very occasionally cancer. Otherwise they seem to live to late 80s/90s - by which time it is hardly surprising they may have had cancer.

And some of the "observational research" on which Ancel Keys based his Mediterranean (low fat) diet saving you from cardiovascular disease was done DURING LENT!!!!!! When next to no good Catholic eats meat and fat or drinks alcohol. Now I understand why the so-called Mediterranean diet bears no resemblance to the diets I've met around that area.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Must admit I'm  a believer in - a little of what you fancy does you good! 

 And I Think those of us born in 1940/50s and maybe early 60s weren't subject to fast foods et al that youngster born later were, so maybe had a better start health wise. 

[Ida-June128 in reply to PMRpro]

Where are you? £1.50 a bottle for pink fizz is right up my strasse!

[PMRpro Ambassador in reply to Ida-June128]

Germanic Italy...

[markbenjamin57 in reply to PMRpro]

I'll drink to that!

[HeronNS]

Should clarify, my reaction to even a tiny amount of alcohol was a raging headache, not a pmr flare.

[Anna135]

It's possibly just a coincidence, however everyone is different and has different health triggers, so it's also possible that in your case alcohol makes the inflammation worse. 

Personally, I don't seem to have an issue with alcohol and GCA when my GCA is under control, but if I'm already having a flare, it makes things worse if I drink. I do already have issues with alcohol causing problems with my bladder, so it's not surprising for someone like me whose body is sensitive to it, that it could interfere with my disease management. 

[Lyn_seaside]

I checked with the doctor about alcohol when I started on Pred and he said absolutely no problem in moderation (mind you, his idea of moderation may be different from mine!).  As far as the Med diet is concerned, we have a house in the very south of Spain and the locals live on pork, chorizo, chips, red wine and brandy.  They live to a ripe old age, but the village is on a steep hill so they take a lot of cardio exercise to get anywhere!

[Doralouise77]

I don't know if it would cause a flareup but alcohol didn't agree with me.  At Christmas I had a couple of sips of wine (no alcohol for 7 or 8 years).  I stood up and promptly fell over.  Felt like.I had drank a whole bottle.   My daughter had the same thing happen to her, says you can't mix alcohol and Prednisone.   Maybe the alcohol canceled out the Prednisone and that's why you have pain, I don't know,  but at least you know not to do it again :-).  I really hope things get soryed and you're not dealing with a full blown flare.  Good luck!

[elainecleary]

Had a bit of a stressful week, so when pouring out the sherry to use in a stir-fry last night (sherry is a good substitute for rice wine), I thought what the heck and had a glass. This morning hands and arms swollen and painful.  Sherry or stress I don't know, I haven't drunk much since PMR not that I did before but think I'll try the experimental route as it did make me feel better last night.

[30048]

My favorite Italian drink is what we call a Venetian spritz .  Proseco, Aparol, and a slice of Orange on ice.  Wish I was there now !!!

[Sandradsn in reply to 30048]

The only time I have a drink is on holiday,we are going to Italy again,I was wondering about having Spritz,last time we went I was well and not on Pred.I will try one anyway!

[PMRpro Ambassador in reply to 30048]

Called a Burdy where I live - when it is warm enough we stop at the pizzeria at the end of our walk and don't have to order, ""Bier and a Burdy, and chips" (as in crisps, patatine). I like Campari Spritz even better. Then there is a Hugo - elderflower cordial spritzed with mint.

Temperature doesn't matter - just has to be sun.

[30048 in reply to PMRpro]

Makes me want to get on a plane......I have to admit I make it here in LA but it is not the same.  I will try the last one you mentioned...it sounds good. Wish I had a pizzeria at the end of my street

[rockyandzeus]

I have had to give up alcohol altogether ( not that I consumed much or often to start with) since being on pred. I did 'try' several times to vary things. Problem with me is that alcohol and pred aggravate heart arrthymia (sp). At its mildest, I would experience a feeling of un-wellness ( not hangover, I don't drink that much) the next day....up to needing to go to Emerg because of heart pounding.

I found that if I don't drink at all, much reduced heart involvement.

As PMRpro suggested, you can try repeating the experiment to see if you get re-producible  results. Have fun trying!

Regards,

Dorothy

[nickm001]

Never add water to a wine... That is the problem :)... Cant say how it impacts you personally, but I had a glass ( or 2) of wine with supper before PMR and continue to do the same after I was diagnosed with PMR... I try to have at least couple of hours between having wine and taking pred, to minimize interaction...

[Polywotsit PMRGCAuk team member]

Hi, just changing the subject slightly.... was at the BSR conference yesterday and by chance there was an informal discussion going on about what we mean by 'flares'.  There was a consensus among the two volunteers and one doctor talking that from time to time, while we have PMR or GCA, the symptoms can take the upper hand and be a bit too strong for us and the dose we are on. But a real 'proper' flare is a return to the acute stage of the illness like it is at the beginning. Would you agree with that?

[HeronNS in reply to Polywotsit]

That makes sense to me.  I found these forums when symptoms began to return as I reduced a little too fast (didn't know better at the time).  I would never have described that as a flare, a word I learned from Patient and HealthUnlocked, and have always assumed that a flare is closer to the original disease with at least some degree of disability.  Do we need another word to describe the small increase in symptoms that could presage a flare if we don't catch it?  Something between "niggle" (which I use to describe the constant little discomfort that is always with me but never gets worse) and "flare".

[PMRpro Ambassador in reply to Polywotsit]

No, after all these years I don't think I'd define it like that and US doctors several years ago didn't either. A flare is simply a return of symptoms - doesn't matter what reason. The most common cause of a flare is reducing the pred dose too far or too fast they said. 

There are two fundamental reasons for symptoms returning. In one case the pred dose remains stable but the activity of the underlying autoimmune disorder increases so the inflammation pool also increases and either alone, or in combination with the early morning pulse of new cytokines being shed, the pain and stiffness resurface. In the other, the activity of the underlying autoimmune cause of the inflammation remains stable but an attempt to reduce the pred dose means there isn't enough to cover the inflammation as the new bit is added every morning. That is why it is crucial to reduce the dose in very small decrements and stay at a new dose for at least 2 or 3 weeks to be sure it is still adequate - reductions that are large or too frequent mean you develop a flare but have no idea at all at which dose you crossed the threshold.

If you react quickly to the signs of a flare when it happens due to reducing the dose then it won't get as bad as it was at first. Of course, if you or your doctor deny that is what is happening then it will get bad. That is when it is particularly important to react fast - and treat the symptoms rather than the figures - since the ESR/CRP often lag well behind.  

It is a different matter when the underlying autoimmune disorder flares in activity - that can happen overnight to a patient on a low dose of pred and leave them as bad as at the outset. It nearly happened to me recently - but while I was quite happy to go back to 10mg from the 5mg I had been at for a couple of years, my rheumy-trained GP insisted on 15mg immediately. I've needed it and after nearly 3 months am still struggling to get the dose lower without the symptoms returning. had I stayed on a lower dose it would have left me as bad as in previous flares.

 If the flare is due to overshooting the correct low dose you can manage it quickly - when it is due to a real increase in disease activity it is a very different matter and may take far longer to get under control. 

But a flare is just a return of symptoms - how bad it becomes depends very much on your/your doctor's response to it.