Newbie

[MichelleH16]

Hi all

I'm new on here and to PMR I had been going to doc with sore throat, tongue and aching hips shoulders etc since January. Doc kept doing blood test's every 2 week but the inflammation markers weren't going down, then the other week I just mentioned the pain was going into opposite shoulder and that I couldn't get dressed and undressed as couldn't reach down to my feet.

This time doc said she would check arthritis markers as well.

When I got home I researched my symptoms and found they matched PMR.

I waited for the usual call to say comeback in to have tests repeated and see doc like usual but they didn't ring so I rang surgery reception who said they havent requested a repeat so they must be ok.

I already had my next appointment arranged for next week to see the doc but I was in so much pain. I phoned for an appointment after the bank holiday. Saw a different doc asked if it could be PMR was told all the symptoms fitted and prescribed preds at 30mg a day and told to book some more bloods and would be referred to rheumatology.

I've been taking the meds 3 days as have existing stomach problems was told to take with dinner and tea. The pain has eased a lot. I was reading the posts about entric coated preds and didn't know whether to ask for these as I'm struggling to control my newly diagnosed hiatal hernia.

Grateful for advice.

Michelle x

[DorsetLady PMRGCAuk volunteer]

Hi Michelle,

Have you been prescribed PPI (Omeprazole, Lansoprazole or like) along with Pred or for your hiatus hernia? If not you should have been, especially if small dose of aspirin also prescribed.

You probably should discuss enteric Pred with your doctor considering your HH. I think they take longer to take effect than the uncoated tablets, 3-4 hours as apposed to 2hr.

Don't have personal experience of the enteric tablets, but sure others who have will answer shortly.

[MichelleH16 in reply to DorsetLady]

Hi Dorset Lady

Thanx for your response.

yes I'm already on ppills. I've recently had my meds for hh changed as the symptoms were getting worse I'm taking Esomeoprazole 40mg and retindine 170mg at night but I'm suffering reflux in the night. saw ent doc yesterday who also said to take gaviscon advanced at night to try to stop sore throat.

[Hidden]

Hi Michelle

I was started on Enteric Coated Tablets when the Consultant prescribed them but GP would only give me uncoated on because they were cheaper, then promptly increased my PPI, so where do you go from there?

Have a conversation with your GP about the benefits of the coated ones then you may be able to take them earlier in the day, which may benefit you more.

Hope you feel better soon & the Prednisolone doesn't impact on your other issues.

Best Wishes

Mrs N x

[PMRpro Ambassador]

Yes, tell them you need enteric coated - although with the armoury of stuff you are on it shouldn't make that much difference.

You mention "dinner and tea" - the pred should be taken in a single dose first thing in the morning.

[Hirwaen in reply to PMRpro]

Hi pmrpro, I have been reading all advice given, especially yours as you seem to have all angles covered. I am new to this, but decided to try taking Pred at around midnight to avoid pain in the morning. It seems to be working,(17.5at the moment)Why do you say it should only be taken in the morning?

[PMRpro Ambassador in reply to Hirwaen]

It is more the "single dose" that is significant, not spreading it through the day. However, the earlier you take it in the morning, the better day you will have! The inflammatory substances are shed at about 4.30am and then get to work. The sooner after that you take pred the less damage they can wreak. The optimum time is 2am - no inflammation happens at all in that scenario.

Some doctors will insist on the 8-9am timing because a study showed that taking 5mg at night suppressed adrenal function more than taking 15mg at 9am. That is all well and good in patients who are on a short course of pred and will make stopping it after up to a couple of months easier. However, as you know, pred for PMR is not a short term process, it is years probably and in that time adrenal function is going to be compromised anyway. So you take it when it works best. But spreading it in dribs and drabs across the day isn't a good way to go. Some people find they need a top-up but even that usually works best as a big dose early, smaller dose later.

[Hirwaen in reply to PMRpro]

Thanks, I haven't split the dose and don't intend to, GPs don't see us first thing when we are sore so don't appreciate the value of taking Pred in the early hours, as I said before midnight seems to work for me.

[PMRpro Ambassador in reply to Hirwaen]

If it works for you - that is what matters. A lot of doctors - who don't know because they have never tried it - will claim it will disturb sleep. For some people - but not everyone.

[MichelleH16]

When I saw doc he just said your on high dose of ppi and to take after or with food and said dinner and tea. however I did take them earlier in the morning yesterday.

wondering if I would benefit from waking earlier to take ppi and then taking preds a couple of hours later?

[PMRpro Ambassador in reply to MichelleH16]

The earlier in the morning you take the pred the less inflammation and stiffness will have developed - the inflammatory substances are shed in the body at about 4.30am. It probably matters less at the moment because you are on a pretty high dose for PMR but it may do later once you get to a lower dose.

[MichelleH16 in reply to PMRpro]

Looking for a bit of advice I'm thinking of maybe taking my pred in the early hours as I get up at 5am but unsure when to take the ppi as I have the hiatus hernia, would I need to take it an hour before I take the pred for it to take effect or would the ranitidine taken at night be enough to protect my stomach?

[PMRpro Ambassador in reply to MichelleH16]

PPIs and ranitidine work for up to 12 hours. You would have to try to see if it works for you but many people who take their pred during the night/early morning do so with a tub of yoghurt/glass of milk or a sandwich.

[Rugger]

Regarding cost of enteric coated vs uncoated, don't quote me, but I think it's in the region of 5p a tablet vs 2p a tablet - we're SO CHEAP! Your pharmacist will tell you, as well as the cost of all your other meds and then you're prepared when you see your doctor. My GP didn't quibble over prescribing the coated tablets. I assume you're trying to sleep with more pillows too? I do that, but it doesn't do much for my PMR neck ache!

[PMRpro Ambassador in reply to Rugger]

Not any more it appears! The price of "ordinary" pred was increased by a LARGE amount in the autumn. How that will pan out long term is going to be interesting!