Hi, I'm new here...: This site has been great for... - PMRGCAuk

PMRGCAuk

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Hi, I'm new here...

GOOD_GRIEF profile image
19 Replies

This site has been great for learning about PMR, and I want to thank all contributors for their time and efforts to share their experiences and wisdom.

I just turned 62 on the 1st of July. Last year at this time I was swimming in the Atlantic Ocean at Southampton, happily body surfing the waves. This year, I can't walk across the sand to perch on my chair.

Last fall on Holloween, I noticed some soreness in my left bicep. I didn't think anything of it. A day or so before, I helped my husband remove the window air conditioners for the season, and thought I merely strained it. Spent the next weekend raking leaves from our yard, and had a little more soreness in the left and new soreness in the right biceps. Again, thought nothing of it. Yard work is hard, and muscle soreness is normal, especially when you're at it in cool October weather. I've had experience with tendonitis before, and really was not concerned when the soreness progressed over the next few days. Taking buses and subways to work often means standing and "straphanging", so I thought what was happening was that I was just wrenching my arms as I hung on, making things worse.

When I woke up the morning after Election Day (gob-smacked by the results), my biceps were burning. After checking my heart rate and convinced I was not having a heart attack, I took a shower, applied Aspercreme (my new body lotion now) took ibuprofen, and took off for work. Doing anything else was not an option as I was heading a major year-end project. Got some relief using alternating hot and cold gel packs, Aspercreme, ibuprofen and a few hot toddies here and there in the evening.

It was 3 weeks later when I started having trouble walking. My legs felt like jelly, and my thighs were getting sore. My hands hurt and were swollen, and I could not make a fist. It hurt to write. It was then I understood that something was really wrong, because tendonitis doesn't migrate. My regular doctor was on vacation until after the New Year, so I went to an Urgent Care center sponsored by my insurer.

A nurse practitioner listened to my syptoms, prescribed 10mg of pred, and scheduled me for an appointment the following week with an attending physician.

I got some relief from the pred within hours. But within a couple of days, though my legs were better, I was having trouble raising my arms. By the time I saw the doctor, I could only raise my elbows to the height of my shoulders unless I was in a hot shower, when I could force my arms to extend over my head. Still couldn't make a fist.

I have to say I feel very lucky that the attending physician that day really knew her stuff, beause she referred me to a rheumy immediately trelling me I had some form of arthritis, and upped the pred to 15 mg. She order a full slate of blood tests and xrays so I would be armed with some information for the rheumy. She called to say all was OK (sugar, cholesterol, D etal.) except for very high inflammation markers and and indication of RF factor, possibly indiciating some form of arthiritis.

I couldn't get a rheumy appointment until the third week in January. In the interim, everything got worse. The burning pain in my arms flew into my hands, and the weakness in my thighs returned and then turned to real pain. It got to the point where I could not sit up to get out of bed. But work I must, so I devised a method of hooking my foot under a dresser drawer to leverege myself up. (I had to remember to leave the drawer open the night before or I'd have to wake my husband to do it for me.) I got to work every day, though I started going in later so I could get a seat on the bus. I was also having trouble with my hands swelling, with the spaces between the joints of my fingers so swollen I couldn't close my hands.

The rheumy diagnosed PMR immediately and upped the pred dose to 20mg split morning and evening, along with Vit D gelcaps and Calcium/D3. I told him I was taking 400mg of ibuprofen every 4-5 hours, and he said I could continue as long as I took all of my meds with food and plenty of water. He wrote orders for new blood tests to be taken a week before my next appointment scheduled for mid-March.

I was feeling great within a week. Almost normal. The weakness had gone, and all that was left was some residual soreness in my bicpes. Annoying but not awful. My hands were less swollen, with some pain in the heels and along the pinky sides, but I was still having trouble making fists because the spaces between the joints of my fingers were still swollen.

The mid-March appointment never happened. A major snow storm kept him on Long Island, a long commute from his practice. He called to say the inflammation markers were down, and ordered another prescription to continue at 20mg. Next available appointment - mid-April. He ordered another set of blood tests and xrays for the next appointment.

By that time my hands were closing (though still couldn't make a fist), I could climb and descend stairs normally again, and even treated him to a little soft shoe dance as a demonstration of recovery.

At that appointment, I was feeling even better. Still a little residual soreness in my biceps, but only noticable when I moved in certain ways. Fingers still swollen. He said that though my xrays were clear of any indication of RA, he suspected LORA, and he wanted to introduce MTX. I said absolutely not. None of my joints were bothering me, or were swollen, or showed any sign of weakness or pain or infelxibility. We argued. I won. I did agree to start tapering the pred since I was getting the hampster cheeks and begining to get the buffalo hump along with pred belly. He told me to go down to 18.50 right away, then down to 15mg after 2 weeks. I did. Big mistake.

Within 2 weeks I had Achilles tendonitis in both legs, both ankles swollen above and below the joints, swelling in a ring below my knees, and the biceps pain back with a double vengence. I went back up to 20mg and stayed there until I saw him again in June.

By then I was again feeling better. I still had tendonitis in the Achilles and swelling above and below the ankles. Blood tests showed all was normal except inflammation makers, which were approaching normal. He said he wanted me to begin the same tapering again, and I said that was going to be too fast. He again wanted me to take MTX and again I refused. Then he offered lufonomide. I refused that, too. I told him that according to my reading and according to my body, I had none of the symptoms of RA, and I had no intention of taking those drugs unless and until he could prove that I had RA. I wasn't going to take that poison to treat a condition or disease I didn't have. He offered Plaqunil, saying it was the mildest of the pred-sparing drugs available, and was very well tolerated. I said write the script, and after I do some research, I'll decide. He said pred is dangerous. I said so is inflammation.

Research on Plaquenil told me that I should see my opthamologist before I started taking it. I've already had cataracts removed from both eyes several years ago, so I want to understand how this medication might effect that. That appointment is next week. I'm starting tapering today to alternate between 19.5 and 20 mg on split doses daily (10 in the am and 9.5 in the evening on new dose days). We'll see how that goes over the next couple of weeks. And we'll see what my opthamologist says about my eyes and Plaquenil. I also don't see how I'm going to manage the gastro-intestinal side effects with a 1.5 hour commute to work in each direction.

The Achilles tendonitis has abated, thank goodness. Still have swelliing in my fingers in the spaces between the joints, so still can't make a fist but my hands are stronger, pain-free and completely flexible. Some swelling above and below the ankles reduces with iced gel packs and returns to almost normal, though swelling comes at the end of the day. There's still some stiffness there, so beach walking is out for a while. I won;t be doing any ocean swimming till the water warms more. It's still under 70 degrees.

So that's my story so far. I hope it isn't too long. Please share your thoughts and your wisdom. I've always been "disgustingly healthy" as my GP describes it, so I'm a babe in the woods when it comes to dealing with these issues.

Wishing you all the best...sunny days and sweet dreams.

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GOOD_GRIEF
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19 Replies
PMRpro profile image
PMRproAmbassador

Of all the steroid sparers your doctor has suggested - plaquenil has the least evidence for effect in PMR. And none of them are sweeties! I really would love to know why they are SO scared of pred. Used properly and carefully in PMR it need not be as bad as they believe. After 8 years I have no apparent adverse effects - I had some while on Medrol for about 9 months but have had none with prednisolone (my first steroid) or prednisone (current).

Are you on Medrol? Have you had a history of being put onto ciprofloxacine or any other antibiotic of that group? At any time. Have you ever had psoriasis or is there any in your family?

The sausage finger syndrome you describe isn't usually found in PMR - swollen fingers maybe but rarely as bad as you mention. But it and achilles tendonitis are found in spondyloarthropathies and they can present very like PMR. I wonder why he plumped for LORA?

GOOD_GRIEF profile image
GOOD_GRIEF in reply to PMRpro

Thanks for your response.

I think I took Cipro for stubborn UTI decades ago. I don't recall that Cipro was the antibiotic when I had my cataracts removed more than 5 years ago. That's it for antibiotics.

My fingers are swollen on the insides of my hands, between the joints. Not on the upper side from the back of my hands, and not across the finger. The joints are not swollen. All of the fngers curl at every joint, but beause of the swelling between the joints, I can't curl the top digist under as I always could before. There's no pain or stiffness and they are just as flexible and dexterous now as they were before this all started.

No one in my family that I know of has had any autoimmune disease. My family is quite small, however. Both of my parents were only children. My mom had osteo in one knee from an injury. So does one of my brothers. My sister has a bunion in one foot after a ski accident decades ago. I think my dad had a couple of broken knuckles from his youth that had osteo too.

I also seriously doubt spondyloarthropathies, as I have no back pain whatsoever, have better than normal strength and fexibility in that area for my age, and never have had any back pain unless I have been shoveling snow ;\}.

He said he suspected LORA because I had a slightly elevated RF factor in my initial tests ordered by the attending physician at the Urgent Care. When I asked for the current level, he said he hadn't retested. When I asked why not, he said it wasn't necessary. As I understand it, RF is not necessarily a predictor of RA since it can be present in people with no symptoms of anything whatsoever, and conversely, RA can be present without RF Factor.

In any case, I have had no joint pain or swelling anywhere in my body. I have had muscular, tendon and ligament pain, and swelling in the soft tissues away from the joints. No back pain. No hip pain, No neck pain. No shoulder pain. No wrist pain. No elbow pain. No thumb pain. My ankles swell above and/or below the joint at the end of the day, but not every day. When the swelling is down, I can dance. No problems in balls of feet, toes or foot. I do have heel spurs, and they sometimes hurt when I'm swollen and walking home.up the hill from the bus.

I am tapering at a much slower pace than he prescribed, reducing to 19.5/20mg on alternate days over the next couple of weeks to see how that goes. If it works, I'll go to 19/19.5mg and try that.

I'll take whatever medications I need to treat whatever conditions I have, but I'll only do it based on science, not on a hunch, especially one that doesn't match my symptoms. These meds are far too dangerous to play around with. Pred is no picnic, and there are dangers there too. But I don't see how having more inflammation and being ill for 3 of 7 days is a better alternative, especially since the only side effects I have are the moonface, the hump and the belly. Sugar is normal. Cholesterols are good. D blood levels are good. All of them always have been, before and during this course. Once the pains subsided, my sleep patterns are undisturbed (I never have been a world champion sleeper.)

Thnaks for sharing your knowledge with the community. You are a wonder.

PMRpro profile image
PMRproAmbassador in reply to GOOD_GRIEF

I asked about the cipro because it and corticosteroids can cause achilles tendonitis - and apparently it can happen even with a history. Mine happened when I was given cipro while on Medrol - it wasn't funny, I spent 9 months on crutches!!!! No joke when you have PMR...

GOOD_GRIEF profile image
GOOD_GRIEF in reply to PMRpro

Could that still be a probelm decades after Cipro?

PMRpro profile image
PMRproAmbassador in reply to GOOD_GRIEF

According to the stuff I found when I did my belated drug search it can happen at any time. Of course, had I not trusted the GP and the pharmacist it would never have happened! Never again! Medrol is worst but it can happen with pred.

GOOD_GRIEF profile image
GOOD_GRIEF in reply to PMRpro

As I recall, I used Cipro a few times 30-40 years ago. That ;s some half-life (haha).

Does Cipro do something to the tendons that goes unnoticed unless and until one uses pred, even decades later?

PMRpro profile image
PMRproAmbassador in reply to GOOD_GRIEF

I honestly don't know - just found stuff in the medical literature that said historical use could be a factor although Wiki says "months". I imagine there could be some effect for longer. It was the reason for the black box warning from the FDA,

"The black box warning on the U.S. FDA-approved ciprofloxacin label warns of an increased risk of tendinitis and tendon rupture, especially in people who are older than 60 years, people who also use corticosteroids, and people with kidney, lung, or heart transplants. Tendon rupture can occur during therapy or even months after discontinuation of the drug.[44] A case control study[45] performed using a UK medical care database found that fluoroquinolone use was associated with a 1.9-fold increase in tendon problems. The relative risk increased to 3.2 in those over 60 years of age and to 6.2 in those over the age of 60 who were also taking corticosteroids. Among the 46,766 quinolone users in the study, 38 (0.1%) cases of Achilles tendon rupture were identified. A study performed using an Italian healthcare database reached qualitatively similar conclusions.[

Can't be 40 years - only been in use since 1987 ;-)

GOOD_GRIEF profile image
GOOD_GRIEF in reply to PMRpro

It could have been in the 80's that I took it, and used something else before that. It's a long time ago, now.

Marilyn1959 profile image
Marilyn1959 in reply to PMRpro

PMRpro. Can you explain the difference between prednisolone and prednisone please?

PMRpro profile image
PMRproAmbassador in reply to Marilyn1959

Prednisolone is the active form of the drug. Prednisone is an inactive precursor which has to be processed in the liver to form prednisolone before it can work in the body.

1Purplecrow profile image
1Purplecrow

Hi, I am not the expert on other drugs, but I know Pred, and it has become my best friend. Taking it for 4 years, I have not experienced the "horrors" about which I was warned.

About 6 months into my PMR journey, my consultant began pressing methotrexate , I decided not, ....and continued with the cheap little white pills.

Today, PMR and I continue our dance. prednisone controls the dance card, and I have come to know and trust this drug for its direct cause and effect outcome. If it works, don't mess with it.

GOOD_GRIEF profile image
GOOD_GRIEF

Thanks, crow. Being a New Yorker has it's advantages. We're born and bred pushy, and never more so when some authority is trying to assert their authority without presenting evidence to support their authority.

I'm searching for a new rheumy.

1Purplecrow profile image
1Purplecrow

Excellent attitude. Like my momma always said...

never trust strangers who are pushing drugs. Remain the skeptic, do the research, and listen to those who have walked the road ahead of you!

I've come to believe we must be our own best advocates when it comes to this PMR business.

With the help of this forum, and its resident (and ever- present!) experts, We know as much or more about PMR than most docs who treat us.

Kind regards from Washington state! Jerri

GOOD_GRIEF profile image
GOOD_GRIEF in reply to 1Purplecrow

Thanks, crow. I'll be learning from all of you.

Have a happy day...

SheffieldJane profile image
SheffieldJane

That was a brilliant description of how this rotten disease comes on and the " friends " it brings with it. Well done for being the intelligent patient that you are. You will be back in the Atlantic Ocean before long I bet.

GOOD_GRIEF profile image
GOOD_GRIEF in reply to SheffieldJane

Thanks, Jane. I was afraid it was kind of long-winded. Hope it helps someone else.

Rugger profile image
Rugger in reply to GOOD_GRIEF

That's the first 'chapter' of your diary. Keep on documenting for your own records, as no doubt you are. Good luck with your search for a good rheumy - I'm seeing one next week after a 6 month wait on the UK NHS!

GOOD_GRIEF profile image
GOOD_GRIEF in reply to Rugger

I've found the easiest way for me to keep a "diary" is to send an email to myself. I keep so many files, journals and spreadsheets for tracking work projects that I know I'll never do it for myself. I use time on my work commute to write doses/time/aches/pains/food/sleep/exercise/test results/dr appts in an AM and PM email. I just call up the prior email from the Sent box, forward it to myself, and add the new info in a new email in the string. I start a new string on the 1st of each month. If something unusually good or bad is going on, I'll send an email in the middle of the day.

This works for me because I can access it from my business or personal smatphones, tablets, destops etc. It's searchable and stored in the cloud, so it won't get lost. And since I'm almost always within reach of one device or another, It actually gets done.

Rugger profile image
Rugger in reply to GOOD_GRIEF

How organised! An e-diary!

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