Hip/Knee replacements and polymyalgia

[Suedeshayes]

A retired doctor proposed to me that my double knee replacements had put too much strain on my immune system which could have contributed to me having polymyalgia 2 years later. It’s an interesting thought and thought I would share. 🤔

[PMRpro Ambassador]

Trauma of any sort does put a strain on the immune system - enough for it to upset it big time for some people. But 2 years seems a long incubation time!

[Suedeshayes in reply to PMRpro]

Actually, it was less than that. Probably nearer 14 months.

[Sandradsn]

Interesting.I've always thought PMR is the way my body has hit back at me for various 'traumas' going on before being diagnosed.

[caterpillar]

yes... it seems to me that everything has gone downhill bodywise since I had a terrible time with appendicitis, which took far too long to dx, with so much pain I used to vomit, and by the time they operated on me my appendix was inflamed and leaking and had collapsed half my bowel... I have not been 'right' since...

[Lynnray]

Oh I’m going for my pre op tomorrow for a knee replacement , I’m down to 6 mg t feeling a bit rough shoulder and arms are very painful, don’t know weather to up my dosage or wait till I have the op in August as I’m worried about the affects of the op on my pmr?

[PMRpro Ambassador in reply to Lynnray]

Discuss it with the anaesthetist

[Lynnray in reply to PMRpro]

Thanks I will probably during the op as no general ugh,,,,,

[PMRpro Ambassador in reply to Lynnray]

No - before. You need to be as PMR-free as you can be for post op and rehab - you need your arms and shoulders a LOT for the walking aids you will need to start with. And the anaesthetist needs to know beforehand that you have been on long term corticosteroids.

If you are in the UK you may well NOT be conscious during the op, even without a GA. When I had orthopaedic surgery in Italy I has no sedation of any sort besides the spinal anaesthetic (which was fantastic). Years before I had been conscious in the UK during a c-section with an epidural too. But when they removed the metalwork from my leg a year or so after my accident in the same hospital as the c-section had been done I was given temazepam before going to theatre so I slept all the way through. I wasn't amused - in Italy I had been offered music but spent the entire time improving the anaesthetists' English conversation skills! They took it in turns to chat to me

[Lynnray in reply to PMRpro]

Thanks I will ask to speak to them before the op.

Sounds fun In the theatre , my husband works in the film industry so lots of funny story’s to tell,,,

[Tonylynn in reply to Lynnray]

When you suffer trauma, whether it be a tooth extraction or a major op the adrenals respond by increasing their output of cortisol. Patients taking pred may well have adrenals that no longer respond to the trauma and fail to increase the level of steroids. The advice I have seen is that if you are taking 5mg pred or less then no action is required but for those taking more it is advised that the steroid dosage is increased for a while depending on the level of trauma, steroid dose, duration etc. Always check with your doctor, anaesthetist, surgeon.....

[VAl4266]

Yes that's exactly what happened to me,I believe that's why I got PMR,,the physio took my bandage of to put some cream on ,to check my stitches were dissolving,on gave me a massive infection, went on for months,then, I got. PMR . Convinced

[Rimmy]

I think this is certainly a possibility - the subject of either or both physical or mental trauma contributing to or triggering PMR/GCA and other AI diseases has been discussed here before. The time frames possibly involved are of course be debatable but many of us have reflected back and realised we had some symptoms of PMR and/or GCA quite a while before we had what might be called or diagnosed as a 'full-blown' disease.

[sjbeck]

I had total knee replacement on March 12, 2019--recovery went well. By 4 months out, I had no pain and was walking 1-2 miles/day. However I started having pelvic, buttocks, back, shoulder and arm pain very soon after that. After having several MRIs and blood tests, my primary doctor diagnosed me with polymalgia rheumatic. I started on 15 mg of Prednisone about 8 days ago. 75% of my pain is gone; I still have right arm pain that starts about 4AM and continues even with 2 ibuprofen until about 12-1:00 pm. Then all my pain is gone. I am now walking about 4miles/day. I don't always feels very good; some days I am overly fatigued and my chest hurts. But I am so happy to have a diagnosis and a treatment plan. I know my PMR is a immune response to my knee surgery. I just hope it goes away soon.

My husband had total knee replacement and he too, after 3 months became very ill and was diagnosed with Non Hodgkin's B cell Lymphoma. I truly believe that this immunity disorder (as well) was brought on from the trauma of his knee replacement.

[PMRpro Ambassador in reply to sjbeck]

"I know my PMR is a immune response to my knee surgery"

Maybe - but the immune disorder that underlies PMR is believed to be the cumulation of many such insults to the immune system. One is finally the straw that breaks the camel's back - and that could as well have been the surgery as anything else. A lot of people associate PMR appearing with previous surgery/illness so it could have been reactive but I don't think theirs disappeared any sooner than that of others.

[sjbeck in reply to PMRpro]

Thank you PMR pro for your reply .

I re-read my post and found I did not articulate exactly my thoughts. My main concern is that my anti-inflammatory response (now diagnosed as PMR) is connected to the knee appliance surgically implanted about 3 months before my PMR symptoms appeared. One would think that if this were the case, I would also have some local response as well ie knee swelling, pain, immobility). I do not have any of those symptoms. My knee is working perfectly and I have no pain, no disability. However, I still believe the new knee has something to do with my PMR symptoms.

[PMRpro Ambassador in reply to sjbeck]

It could be just the actual surgery - trauma of any sort will affect the immune system, it could have been the final straw. There is, of course, no way to know whether there is also a reaction to the prosthesis

[sjbeck in reply to PMRpro]

Yes, you are right. Just so frustrating as I do all the right things to stay healthy; eat a very fresh diet high in organic vegetables, low in meat, exercise daily, have good social outlets and very involved with family. I know that my lifestyle will help get me through this bump in the road.

Thank you for your thoughts PMR pro

[Snibby]

I think the pain of severe hip athritus has contributed to me having PMR 6 months ago. Also 2 years ago I lost both parents within 6 months and a close friend I also think the grief stress has triggered it. So interesting what you posted