In early July, 2016, while vacationing in the Adirondacks of New York, I began to suffer from significant night pains in my shoulders and hips that completely resolved during the day. When the night pain became widespread, and began to continue during the day, I called my primary care physician and made an appointment to see him on August 2. I then began to search the literature for the cause of my problem.
Based on symptoms, I learned that I was likely suffering from PMR and the treatment would include long term-high dose steroids; which I knew were associated with a significantly increased incidence of bone loss and fractures. Concerned that this treatment might further compromise a colossal spinal injury I suffered in 1995, I searched for treatments that would reduce the cumulative total steroid use
As a consequence of my search, I located a 12 month pilot study and a 96 week controlled trial (Dasgupta, 1991,1998) that compared 120mg injections of depo-methylprednisolone (depo-medrol), every three weeks, with oral prednisolone for the treatment of PMR.
Subsequently, my physician diagnosed my disease as PMR and agreed to try the treatment outlined in the trial. Regrettably, I flared on the seventh and fourteenth days, and was almost crippled with pain by the end of the third week. As a consequence, my wife and I graphed the release profile of depo-medrol and used my previous flare points as a guideline to determine that 80mg weekly injections should be the minimum dose necessary to control my symptoms.
We also determined the daily doses (from day one to seven) would be approximately: 20mg, 15.3mg, 13.7mg, 10.3mg, 8.4mg, 6.4mg, and 5.9mg. Moreover, I would have to wait for the residual from the first two injections (that was released into the blood after the seventh day) to combine with the third injection, before I received the amounts listed above. Once again, my very considerate physician agreed to give this treatment a try.
While this regimen doubled the steroid use outlined in the aforementioned trial, it still averaged just 11.4mg of methylprednisolone per day; which is significantly less than the 20mg oral dose of prednisone my doctor determined was appropriate for my weight.
On the fourth day following the first injection, I experienced a flare that resolved fairly quickly, but by the end of the second week all of my symptoms were controlled. Subsequently, on the occasional week, I experience mild to moderate hand and shoulder pain on the sixth and/or seventh nights, when the drug cycle is at the lowest levels.
Interestingly, I went to bed with hand and shoulder pain on one of these occasions, and thirty minutes later it suddenly resolved. Simultaneously, I experienced what I believe was a cortisol induced euphoria. The implication being, that due to the pulse dynamic of the depo-medrol, the hypothalamus-pituitary-adrenal axis (HPA) had remained intact over the previous ten weeks (just as occurred in the aforementioned trial) and produced more than enough cortisol to offset the inflammation that was causing the pain.
It is now apparent (if the HPA continues to remain intact), that when my physician begins to taper the dose, my adrenal system should readily take over and spare me much of the difficulties experienced by patients who have lost all of their adrenal function.
Has anyone else received a similar treatment? Am I correct in assuming that because this regimen reduces the cumulative total steroid use, and appears to spare the HPA, that it may be a superior alternative to oral prednisone? Unfortunately, receiving weekly injections is inconvenient, (and includes some minor pain discomfort), but the benefits may more than offset these issues.