Painful swollen hands

[Ipsy71]

Help!

74 year old husband diagnosed with PMR/ GCA October 2015 started on 15 mg gradual reduction to 8mg in 1/2 mg drops, was doing really well , on info from other sufferers on this web takes Vit D calcium daily , fell down last 2 stairs a month ago badly bruised seems to have made PMR worse, increased to 9mg , still very tired but big problem with hands ,swollen and extremely painful in mornings particularly ,sometimes  heat helps and sometimes cold 

.He take paracetamol but that doesn't seem to help much.

Anyone any suggestions please.

[piglette]

Pred is really the only thing for PMR, paracetamol will not touch it. Has your husband had a blood test recently for ESR and CRP? He has dropped his pred dose quite quickly and will be hitting the dose where his adrenal glands will have to leap into action, possibly making him tired. Has he had a Dexascan?

[Ipsy71 in reply to piglette]

Thanks will take that on board and get a blood test and hopefully a Dexascan.

[piglette in reply to Ipsy71]

I think that would be a help your husband. There is a medical group in Bristol who recommend you should stick on 10mg for a year. That may be a bit much, but it is a good idea to slow down a bit at this point and also at 5mg. Men do seem to be able to get over PMR better than women but that may be a generalisation.

[PMRpro Ambassador]

At just 60 I fell off a bike, almost stopped at the time so not terribly dramatic - and had a real flare for a few weeks as a result. 

As piglette says - paracetamol is a bit of a waste of time and probably not worth the risks associated with it. If 9mg isn't enough then he may need to try a bit more - many doctors suggest adding 5mg to the dose at which the flare occurred for a short time and then back to the dose above the flare. 

Who is he under? The GP or a rheumy? And has everything been properly checked out after the fall?

[Ipsy71 in reply to PMRpro]

Hi 

He sees GP who is fairly reasonable but sees my husband as a fit young 74 year old which normally he is but this cruel PMR robs one of more than mobility, we tend to reduce pred at a rate that his body requires and we're doing well with diet vit supplement s etc until the fall thought he'd cracked a rib but that's all ok and arnica reduced the bruising.

I thought adrenal didn't kick in until he was down to 7 mg , learn something new every day .

Thanks for your help

[PMRpro Ambassador in reply to Ipsy71]

The adrenals start to have to do something for everyday use at something below 10mg - it depends on the person and some need more than others. 7-8mg is perceived as the usual "physiological" dose but it isn't written in stone and it also depends a bit how well your body absorbs the stuff from the gut. But the stress of the fall may have been enough to need more than that anyway - functioning adrenals would produce a spike in response to the shock. At this sort of level the adrenals haven't actually started to work again and so you could have problems because of the trauma and general shake-up - and that CAN happen at any dose I think if the shock is enough.

[DorsetLady PMRGCAuk volunteer]

Hi,

If your husband's pain in his wrists is from something other than PMR, then he can take co-codamol with Pred - I sometimes take it for my arthritis. Needs prescription, and can be a bit unkind on stomach! But as piglette says the only thing for PMR is Pred unfortunately, and yes he is at that difficult dose where adrenals are trying to kick back in, which obviously doesn't help. I felt really wiped out for a long time whilst mine were dithering about! 

Suggest he stays at 9mg for a good while, for the reasons above, and to give him time to recover fully from his fall, which as we all know takes longer as we get older.