I've had an idea

[Jontie]

On my last visit to the rheumy I explained that I'd had a flare when trying to reduce to 9mg after a month on 10. The flare was quite localised (rib cage and sacroiliac joint). He immediately started talking about the possibility of using a steroid Sparing drug if I couldn't reduce. I didn't think of it at the time but wouldn't a better alternative be to continue reducing the oral pred and have a local cortisone injection where it's needed? That would seem preferable to methatroxate. In fact I have been trying the dead slow method and it seems to be working but I just thought I'd see what folk thought of the local injection idea in case the need arises further down the road.

[SheffieldJane]

People do with positive results. I will await your replies with interest.

[SnazzyD]

Hello,

Why was it diagnosed as a flare in these localised regions as opposed to something else?

[Jontie in reply to SnazzyD]

Only by me! Basically, the pain in the rib cage/sternum isn't really helped by the pred so it's always there. But the sacroiliac pain has been bad in the past, went away at 17mg and returned at 9mg. I therefore deduced it was a flare. Do you think I might be wrong?

[Jontie in reply to Jontie]

Oh yes, the SI pain went away again when I went back to 10 mg. So possibly further evidence that it was a flare?

[PMRpro Ambassador in reply to Jontie]

I'd blame myofascial pain syndrome for both those pains. And like Snazzy - I used to get great relief from Bowen therapy. It's the physio now because the Bowen is expensive and a bit "wellness" rather than "therapeutic" if you see my differentiation!

[SnazzyD]

I’m no expert as I have GCA only. I have noticed that above 20 or 25mg just about every niggle and ache was non existent unless I actively pulled a muscle; it is an amazing pain killer. Below that things have crept back, some of which I’m sure are due to weak muscles, particularly accessory muscles. I am now on 9mg and although my big muscles are ok I easily get lower back and pelvic tweaks due to imbalance of the general structure. I go and have Bowen therapy and it fixes it, which tells me it isn’t PMR when I’m having a panic. My general weakness shows up in intercostal muscles and where they join onto the sternum, around the sacroiliac area and muscles from shoulder going into the neck. These have always been my flashpoints for stress too due to postural habits. Since being on Pred, my posture tends to be rubbish if I don’t watch it. It I get pains, I invariably find I’ve gone back to bad habits and my pathetic musculoskeletal system hasn’t let me get away with it. I no longer get away with lifting or picking things up badly.

Anyway, just a thought because it is so easy just to assume everything is PMR/GCA. I’m NOT suggesting you don’t go up in dose if advised but have a really good look at what you’re doing posture wise and any bad mobility habits particularly subtle ones as whatever happens they do need to be addressed anyway for the long term.

[Jontie]

Fair point! Thanks for your input. J

[Hidden]

I had terrible rib and sternum pain last year for a few months at around 15mg. It seemed to disappear as I tapered using another dmard called cellcept or mycophenolate. I dropped to 9mg about 10days ago from 9.5 and my ribs started being tender again and my thighs were very painful. I think it's less of a flare, more that I d dropped a bit quickly and inflammation tap dripped and filled the bucket as pmrpro says. In other words its no longer being controlled . I went Back up to 10mg and will dsns to 9.5mg again. Ribs and thighs seem happy at 10mg so far. There is a rib pain called costocondritis which I think caused my pain last year.

[Jontie in reply to Hidden]

Sounds like you are at a very similar stage to me. Anyway I'll press on with dsns. Makes a lot of sense. Don't know why rheumys don't suggest it.

[PMRpro Ambassador]

My flares are almost always accompanied by problems with my myofascial pain syndrome. One way of improving that is a steroid injection - instead of raising the pred dose. But the physio can also work wonders as can a technique called needling or intramuscular stimulation which encourages the spasmed muscle to relax - my doctors either use lignocaine or saline in the needles, some techniques use solid needles like acupuncture needles.