Is it a flare?

[Deemar]

I was diagnosed with PMR in June 2014. I was started on 20mg of prednisolone and by July last year was down to 5mg. I am still on 5mg. We returned home, in France, on 13/4 after spending almost five months in New Zealand. Thank you for advising me to have special assistance at the airports, it was well worth swallowing my pride. It is not only the walking but also the long waits in immigration queues which are avoided.

Four weeks before we left I went horse riding. I have ridden all my life but had little opportunity to do so over the past three years. I have ridden at the stables there many times during our last visits and know the terrain and the horse I was riding well. I know I shouldn't have done it but I had three good, uphill canters and on the last one felt a tearing pain in my lower back. I was able to carry on, at a walk, back to the yard. I assumed I had pulled a muscle. After two weeks of considerable pain and taking many doses of paracetamol, which helped a bit, I went to the doc there. She said most likely muscle and advised physio. I managed to fit in three visits to physio before we left. She thought it was bone which had been compressed and did give me some relief. Journey back was ok, airline seat supported the area well.

On our return we had six month rdv with our GP on the 20/4 with comprehensive blood test. He checked out my back which was still quite painful and suggested X-ray. He was concerned about the blood test results

Sedimentation rate up from 43 last test in 9/16 to 67.

CRP up from 15.2 to 32.2.

He suggested that I have another blood test in four weeks before seeing the rheumatologist.

At this point I should say that I have much more faith and confidence in my GP than in the rheumy who is always very perfunctory.

So X-ray was last Friday. It showed some small area of compression but doctor there was not sure that that was where I am feeling the pain. Good news is that hips are OK! Every cloud has a silver lining!

E mailed letter from that doc to my GP. He replied this am to say that he believes the pain to be rheumatic and to see him if not seeing rheumy this week. Was planning to visit rheumy the week after next after next blood test. By some miracle my GP has an appointment free at 4pm today so have taken that up.

So is the back allied to the PPR? Am I having a flare? That is the question. It seems that I am getting more stiffness in my legs and slight twinges in my arms. The back pain is like a belt tightening around my waistline . It is quite bearable during the day but very painful when I get out of bed. I have been very, very tired since our return but had put that down to the journey. It's all very insidious isn't it?

[DorsetLady PMRGCAuk volunteer]

Your blood reading increases are probably due to your back injury as much as your PMR. Although that probably won't have been helped by everything that has happened.

If you are taking painkillers and they are reducing the back pain, then it's probably not a relapse, but if they are doing nothing, then it could well be PMR. Might be worth trying an extra mg for a week or so to see how things go. Discuss with GP.

Good idea to have bloods retested, some doctors seem to have a knee jerk reaction to raised bloods, but you really need to see if a pattern is emerging, not just a one-off test.

Please let us know the outcome.

[Deemar in reply to DorsetLady]

Thanks for your reply. Will keep you posted. One thing I forgot to mention. Just occasionally I have a headache, quite mild, which soon disappears. I'm not prone to headaches could this be part of it?

[DorsetLady PMRGCAuk volunteer in reply to Deemar]

Could well be from your back, depending exactly where the damage is.

You can take painkillers with Pred - paracetamol, but shouldn't take NSAIDs (ibruprofen) - although pharmacist did okay using gel sparingly for my arthritis.

[IdasMum]

Oh Dee

Sounds horrible and I hope that you get things sorted.

I agree with Dorset Lady re your bloods...and imagine the stress and strain of being in pain and travelling could well have raised a flare.

Good luck with your RDV later xxx

[PMRpro Ambassador]

If it were me with similar symptoms I'd probably assume myofascial pain syndrome - and spasmed muscles causing the pain. It is pretty common alongside PMR.

[Deemar]

Ok. Consult with GP this afternoon. X Ray shows fracture in vertebra, not compression. Pain when he felt the vertebra was minimal compared to when he last examined there. In view of fact that it is six weeks since injury was sustained he thinks this is normal. Pain there is now only a concern when I get out of bed in the morning. He doesn't think that I am having a flare. What he is concerned about is osteoporosis. I was prescribed alendronic acid meds three years ago but discontinued them due to to severe heartburn and was not happy about the side effects over a sustained period. Bone density test was good last year. GP explained that being at risk of osteoporosis due to sustained use of pred I should think again about taking meds for this as I have now sustained fracture. I have Rdv with rheumy in two weeks and will discuss with him as well as having bone density test. GP suggests treatment with yearly injection. Looking on line all these osteoporosis treatments scare me but maybe there is no option?