I haven't posted for a while. I'm an active 74-year-old working male psychologist and have been diagnosed with PMR since January 2018. I had a flare at 7mg prednisone, went back up to 10mg and after a month have gone down to 9.5mg. I have fired my first rheumatologist, and am waiting to see somebody the UCSF Medical Center (local university med school).
I am very fortunate that I have almost no PMR pain (mainly very mild trochanteric bursitis and iliotibial band irritation) and no fatigue on my current dose of pred. I was quite disabled, however, before getting diagnosed and treated with prednisone.
I have developed Achilles tendonitis in my right Achilles tendon and wonder if other PMR patients have had this problem--and if so what they have done about it. I can only walk a few blocks before I am limping and in pain. is it associated with PMR or is it that the tendons are weakened by the pred? Any insight would be greatly appreciated.
I also want to repeat how grateful I am to this site. If it wasn't for information and reference to papers in the field that I found on this site, I wouldn't have realized that my rheumatologist did not know very much about PMR and much of what she thought she knew was wrong! And I wouldn't be on the slow taper that is working so well.
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lew49
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I remember your previous post from sometime ago and followed it with interest, especially from a psychological perspective.
I don't know what the forum 'Aunties' (experts) will say, but here's my opinion for what it's worth:
Your question: "I am limping and in pain. is it associated with PMR or is it that the tendons are weakened by the pred?"
My best guess? A conspiracy of both - I've experienced the same thing a couple of times on my PMR journey. As you probably already know, Tendonitis can take quite a few weeks to settle down, and there seems to be no magic solution other than resting that leg, maybe some ice packs, maybe some gentle physio and just rolling with it.
On the positive side: limping around (in an exaggerated fashion - and grimacing a lot - obligatory behaviour) can gain you lots of sympathy from people who have probably experienced something similar. So, make the most of it - I always do
But seriously: I hope your Tendonitis improves slowly and it's good to know that this forum is a source of advice and support.
Others I know joined a Nordic Walking class and then continued with it when needed.
I can't comment on the Tendonitis much, but I would have thought that as the oxygen supply is impaired in getting to the muscles. Are Tendon supplied with oxygen?
I snapped a tendon and had an op which was complicated. There were only two ortho guys in the UK who could do it at that time.............one of them up here, it took six months before I could walk again.
DEFO NOPE jinasc (walking stick..?)! Perish the thought...
I find that, with my youthful physique (Ha!) and a theatrically exaggerated painful grimace, I can feign having just had a temporary injury as a Rugby International, Moon walking astronaut, Extreme Sports competitor or the like. It works at the fag counter in ASDA if nowhere else...
On a serious note: a very fit mate of mine (similar age, then about 50-ish) snapped his achilles tendon playing squash a few years ago and still walks a bit lop-sided. Like you, it took several months, plaster up to his knee, immobility, and lots of physio. Then again, he was always a bit 'flat-footed' / fallen arched. Mmmm...
I'm sure you're right about possible oxygen supply to the Achilles as a cause: but it's probably often more to do with physical strain / being out of condition / lack of flexibility etc as much as anything else? That said, I'm not an expert in these things... only guessing.
I'm on 10 (tried to reduce to 9 recently and had to go back up) and my right ankle acts up from time to time, as well as the top of my foot. Occasionally the left, but mostly the right. The top of the right foot has been acting up lately too, but mostly at the end of a long day when the pred is starting to wear off (I take it at 3 am).
I've been wondering whether adding the occasional dose of Tylenol (paracetemol) has actually been bad for my tendons though good for pain management...
Good to hear from you again lew49! I hope you get some sound advice. I have definitely experienced muscle weakness that I believe, is another downside of Pred. I find that my ankle or knee gives painfully on stairs. Currently, my main concern is my Adrenal function, so I don’t mention it to my GP. A good physiotherapist could help though.
Glad to see you have a new rheumatogist at UCSF. I got good treatment there years ago for RA, and my current rheumatogist was trained there. No help with the tendonitis, but I am sure others will have advice tomorrow.
As a science educated man, you will be looking for answers. Knowledge is power. I am a graduate chemist, working in analytical pharmaceuticals before retirement. Unfortunately, there are no answers to the questions....where did this come from, what causes it, is this a symptom of PMR etc etc. Research is sadly lacking. Your tendonitis could be part of PMR, a side effect of meds or tendonitis you would have got even with no PMR. Over 3 years I have treated each side effect condition as it has arisen...pre diabetes, tinnitus, hearing problems, sinus problems, digestive problems, UTIs, depression and worst osteoarthritis in my hips necessitating 2 hip replacements in 5 months. Would I have got these without PMR or its treatment with Pred, who knows? Just treat them and move on towards better health and a return to a former life.Love your photo......very appealing to ladies of a certain age.
Hi. I learned that Prednisone does particularly weaken the Achilles’ tendon after I started having pain with my left one. I carried on regardless and went on to rupture it-plaster for 3 weeks and a boot for 6! It is in the very small print in the, contre- indications. I was unaware that the Pred does this and I think that perhaps you should see a physio for particular strengthening calf muscle and Achilles’ tendon exercises. My right Achilles also gets painful, but now I am very careful and I do exercises each day to try to keep them in check.
Pred itself can cause achilles tendonitis - especially in the form of methyl prednisolone (Medrol). The risk is increased if you have a history of use of quinolone antibiotics (their names end in -oxacin and the most commonly used is Ciprofloxacin which has a very dodgy reputation you may have heard of) and that persists for some time.
While the innocent may decide to push on and limp to gain sympathy, if you have an inflammed achilles tendon it may well pay to see an appropriate doctor and get a boot and crutches to protect it while it recovers. An inflamed achilles tendon is a delicate flower and - as Suedeshayes found out - can rupture easily. If it snaps altogether you are talking of serious surgery. I had a boot for a month or so and then was adjudged OK to just use crutches to reduce the risk of tripping - I used them for the best part of 9 months. Just stepping off the kerb badly can be enough to do the damage.
I posted a wee while ago that I had developed Achilles tendon problems - but I was on a 'high' dose of Pred at the time for a flare with my GCA. I have now tapered back down to a lower level and (probably accordingly) this problem has pretty well rectified itself. Although I did not rupture the tendon it was very painful and I began have dreadful nightime - long lasting calf cramps in that leg which were 'hell' and lasted for 2 weeks. As I had not actually ruptured but strained the tendon in some way I did not wear a 'boot' but rested it initially and gradually moved it more and more . A physio gave me some exercises - but they actually initially made it much worse so I proceeded with this more 'gentle' treatment. A boot may temporarily 'help' but I am pleased i did not resort to one of those as I managed to get my leg moving 'normally' much more quickly than most seem to have done and even my doctor anticipated - but it was still one step forward and two back for a couple of months. This tendonitis is (I think) almost certainly related to Pred which is known in some people to 'cause ruptures' and/or to actually (in conjunction with some other variables) 'alter' the 'micro-architecture' of our muscles. This article which is rather more about 'rupture' indicates some of the issues which may be implicated and so may be of interest to you.
Usually treated with an 'equine lower leg half-cast boot'. The 'equine lift' (angled lift wedge) relieves the stretch on the Achilles. If no boot prescribed, then ensure to wear a slight heel, akin to a 'Louis heel'. A Louis will effectively perform the same action, though not as good as the Equine lower leg half-cast with in-built heel wedge. The half-cast is open fronted and can be removed for showering, bathing etc, and at night. In order not to strain opposing leg, useful to also lift the opposing heel - put in a heel lift / silicone wedge to help.
Useful *general article, though not all will apply : i.e. surgery, not unless have ruptured...
Suggest seeing specialised orthopaedic person to discuss treatment. BTW, icing will help calm inflammation. Do *not use heat.
I wore my half-cast equine (open-fronted 'pot' - which I have kept, just in case have to reuse !) - **inside a walking boot. Excellent. Otherwise one is hopping and could fall etc etc.
Hi Lew- I am in Florida and in medical public relations and yes, you guessed it, research the heck out of everything. While on prednisone I have had pain in the Achilles but it goes away. I wore an ankle support sock to manage the pain. You note that you have had pain in other parts of your body most likely the result like all of us aging. But my rheumy said pain in these areas can also come from the prednisone. So it’s a catch 22. Although if I were to make an educated guess, I would “think” the prednisone would help manage the pain in those areas. Just follow the plan you are on and tapering carefully and see if your doc wants you to have an X-ray. Your going to a great place for care and tops in their field. The new rheumy might increase your dose. BTW what was your last ESR ( Sed) rate and CPR. Also have they done a metabolic panel test yet? 🙏🏻
After five years of Achilles’ tendon problems mine were sorted out by surgery. My rheumy thought they had nothing to do with PMR but as Psoriatic Arthritis can affect them he investigated that and tried me on Methotrexate for six months. In the meantime I saw physiotherapists and podiatrists. In the end my rheumy concluded that the problem was mechanical and nothing to do with him and PMR.
Eventually I got my GP to send me for x-rays and to an orthopaedic surgeon who specialises in feet and ankles. The surgeon diagnosed Haglund’s Deformity (a spur protuding from the heel bone into the tendons) and I had surgery - and so far so good.
Your problem may be completely different but the feet and ankles are such a complex thing, insist on X-rays at the very least.
I do actually think that PMR plays a part, the pain in our muscles must affect our gait and subsequently our tendons and joints.
"Clinical evaluation and lateral radiographs of the ankle are mostly enough to make a diagnosis of Haglund’s syndrome. The pain could be due to associated Achilles tendonitis and retrocalcaneal bursitis [2]. This condition can mimic other causes of hind foot pain like isolated retrocalcaneal bursitis, plantar fasciitis, and seronegative spondyloarthropathies [3].
"Haglund’s syndrome is often treated conservatively by altering the heel height in shoe wear, orthosis, physiotherapy, anti-inflammatory drugs, and local steroid injection. Surgical excision of the bony exostoses of the calcaneum is only required in resistant cases."
I had Achilles tendonitis on both sides for 4 months after a too-steep and too-fast taper attempt. Nearly crippled me. I went back up to 20 and stayed there until it was over, and was really Really REALLY careful walking, taking curbs and stairs, getting into and out of cars and even chairs. Drank plenty of water and found Aspercreme helped a little.
I was lucky enough to get through it without an injury, but I had to severely curtail my activities. The last thing I wanted was a torn/ruptured tendon to deal with on top of everything else.
14 months on after that ended, I'm down to 6 with no flares.
Treat it like an injury. RICE method helped me, alternating with Thermacare Heat Wraps.
Hi, I have GCA, 2.5 years and started on 60mg pred and down to 5mg pred. When I was on the high doses I could hardly walk, my Rheumy suggested pilates which has saved my life. Last December I tore the tendons in my shoulders (Dog on lead chased cat!!) twice I have strained Achilles tendon for no particular reason and currently have Plantar Fasciitis (inflamed tendons in heel, I upped my walking in the summer wearing very flat shoes). My Pilates coach is also a physiotherapist and believes that Pred or any steriods soften the tendons so that they are more easily damaged, he has helped me so much with just a small amount of treatment, but advice about how I can help myself at home. I go to Pilates three times a week and couldn't live without it. No back pain, helps with morning stiffness and pain, I don't like painkillers they make me drowsy. My Doctors don't really seem to have any opinion about tendons just see them as injuries to treat as and when they occur whereas my coach helps me look after myself. I can't recommend enough Pilates and/or a physio with an interest in preventing illness.
P.S. I don't enjoy exercise classes it is not something I ever wanted to do with my time but have to admit they work
I am once again very grateful for the outpouring of support and advice coming from this amazing website. The advice seems to agree that:
1. Achilles tendonitis can be caused by PMR or prednisone or both
2. Tendonitis tends to resolve as prednisone dosages decrease
3. Tendonitis sufferers should back off of physical activity that might aggravate or even rupture the tendon
The first two points are very useful bits of information for me. They give me hope that I can get this stubborn problem resolved. The last point reinforces something that I have been learning from sad experience. As the tendon has seemed to heal I have done the standard exercises and increased the lengths of my walks from blocks to many miles. Twice now this is caused a crippling relapse! I think that I'm finally getting the message that I need to go very, very slowly in upping the distance. Very frustrating for a hiker, backpacker, and skier.
Wish me luck in finding a competent rheumatologist and thanks again for sharing your experience, knowledge, and wisdom.
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