Can Prednisolone mask Arthritis?

[Valnvaughan]

Hi, looking for any members with similar experience who have advice.

Diagnosed with PMR in July 2015 and GP mentioned " a bit of arthritis in my hip". 15mg Prednisolone prescribed and gradually reduced to 6mg by August 2017. PMR was mainly felt below my waist. In Aug 2017 my mobility decreased markedly and my GP diagnosed a flare and upped my Pred back to 15mg. Got some relief and after one month started another reduction. By November 2017 my mobility was deteriorating again and I observed that it was worse on right side, so not PMR. My GP sent me for X Ray's and these have revealed severe arthritis in right hip, "bone on bone" in fact and moderate deterioration in left hip. GP referring me to hospital specialist but warns I will probably need 2 hip replacements. Now in NHS queue.

Has anyone a similar experience? Did the treatment and Pred mask the arthritis? Any tips for living with these conditions?

[Zampalion]

I have had pmr 6years have reduced to 2mgs pred under 5mgs started to get joint pains arthritis in hands, have been diagnosed also with carpal tunnel syndrome just had cortisone injection in wrist day after now seames to have helped my joint pain, also I have had a hip replacement 2 years ago.

[Soraya_PMR]

I’ve not got low enough yet to unmask anything. But my GP insisted my pains were due to hip arthritis at the beginning, however an x-ray kicked that theory into touch, so I’m hoping not to have to cross this particular bridge.

May I tell you a little about my dog? Absolutely no offence intended here, by comparing you to a dog! But the info has some relevance. She has been diagnosed with Cushing’s disease, excess cortisol. In essence it’s the same as us taking excess prednisolone. As her treatment reduced her excessive cortisol, she has become an ‘old dog’ with limpy stiff hips. She now requires tramadol twice daily for pain. Her medication for Cushings prevents her cortisol production and her levels declined over a few months. In the drug insert it states ‘Treatment may unmask arthritis due to a reduction in endogenous corticosteroid levels’.

I’m sure DorsetLady has spoken of reappearing pains as pred reduced.

Sorry you have this extra pain, hope they’ve given you adequate pain relief. You’ll feel like a spring chicken with new hips, but I don’t envy you the painful wait or surgery. I wish you well.

[HeronNS in reply to Soraya_PMR]

I was in so much agony with hip pain before PMR diagnosis (and all the other pains) that my doctor at the time sent me for a battery of x-rays. I'd been thinking I'd need to gt onto the waiting list for a hip replacement. It turned out that my hips were one part of my body with NO sign of OA. The hips got better with pred, all my pains disappeared at the beginning, and were completely cured after I got some physio treatments on my back a few months later. Hip pain had been caused by very tight muscles in my back and other issues with my spine, referred pain.

[PMRpro Ambassador]

Shame he hadn't confirmed his suspicion with an x-ray at the start!

To some extent the pred will mask developing OA but I think the jury is out on whether it actually causes it. Pred injections can be used to reduce the pain of developing OA but the number of injections into a joint is restricted because the pred in the joint fluid doesn't do the cartilage any good and repeated injections may make it worse. But oral pred shouldn't make a lot of difference except it reduces the inflammation there is with OA too. Everyone is a bit different - some have x-rays that are absolute disaster areas but no pain while others can barely move but the x-ray doesn't look as bad as that.

Hope you don't have to wait too long - everything non-emergency in the NHS is a bit, shall we say, behind!

[Soraya_PMR in reply to PMRpro]

A bit?

[PMRpro Ambassador in reply to Soraya_PMR]

I said something else first but decided it wasn't PC...

[1Purplecrow in reply to PMRpro]

😉

[piglette]

I had the same problem. My GP was very dismissive so I went privately to see an orthopaedic surgeon who said if I did not have a hip replacement within six months I would be in a wheelchair. Going through the NHS fifteen months later I actually had one. The pain in the end was excruciating. I am not sure if the pred made much difference or not.

[DorsetLady PMRGCAuk volunteer]

Hi,

When I was on very high doses of Pred my OA pain, along with everything else was masked, but obviously the OA was still there, and deteriorating as I found out once I got to lower doses and it all came sailing back!

Am on waiting list for knee replacement (hopefully a letter in the post when I get home) plus other knee and right hip not too good....oh and left shoulder as well!

Deep joy!

[Rimmy in reply to DorsetLady]

Oh DL - that list of future 'ops' doesn't seem very 'fair' when you've so elegantly and recently 'overcome' the GCA stuff ... Anyway I hope you really enjoy the last bit of your NZ trip and time with your family there - but pleased you have so generously stayed 'with us' here for the duration - we'd sure miss you if you hadn't.

Best wishes

Rimmy

[GranAmie]

You may be onto something here - my gp gave me pred at 40mg daily in 1999 and gradually i cut it to 7.5 mg over 15 years...... i collapsed in 2015 after he gave me statins and cdn't walk [hospital said it was a reaction to them] but RA diagnosed. Rheumatologist said i must have been in agony as it wasn't new....Despite all that pred my bones are all good,too. but RA not good - MTX damaged lungs, SSZ bad side effects. waiting for appt. swimming when i can and no wheat, meat or dairy help a bit. take care xx

[PMRpro Ambassador in reply to GranAmie]

What were you given 40mg for and then left on it for so long? I also had a similar reaction to a statin - within a week I could barely walk. Never again!!

[GranAmie in reply to PMRpro]

GPs rule, that's why... and I hadn't used my research skills at that stage... and now they're muttering re biologics for the RA... Take care, you