Pain in torso front and rear of rib cage

[Jizer]

Diagnosed with pmr started on 15 mg then reduced to 12.5 then 10. Started to get pain in front and rear rib cage area and slight discomfort in thighs, reduced to 9 for 6 weeks then 8, pain getting worse has anyone else had pain is these areas when reducing and what was outcome.

Thanks. Jizer

[PMRpro Ambassador]

It sounds to me as if you have reduced too soon and too far - you are not reducing relentlessly to zero pred, you are looking for the lowest dose that manages the symptoms as well as the starting dose did.

PMR is not an illness where you take a one-off dose of pred, the inflammation from a short-lived infection is removed and you reduce to stop the pred. PMR is a chronic autoimmune disorder where your immune system is attacking the body in error and leading to a new dose of inflammation on a daily basis. First you clear out the accumulated inflammation and then you look for the lowest dose that fully clears out the new lot each day. Then you stick there for a while. PMR has a median duration of 5.9 YEARS - this is a long haul flight, not a hop across the channel...

You don't say how long you were at each dose but from experience you need a month at least at each of the doses. And reducing in big steps often means you miss the dose you need in the earlier stages - it doesn't mean you won't get lower but naturally enough you tend to need more in the early stages. Over a long time the activity of the underlying illness falls off and you are able to manage on a lower dose.

Ribcage pain may be costochondritis or it may be due to spasmed back muscles as part of myofascial pain syndrome (MPS) - which can pinch nerves. MPS often forms trigger points in pairs in the shoulders, about rib level and in the low back about where the baby's dimples are. Nearby nerves are affected - and the rib level ones can lead to referred pain in the ribcage. Much the same happens in the low back - and causes sciatica (as a comparison).

[Jizer in reply to PMRpro]

Thanks for response, I am a 54 year old male started taking steroids in April 2018. I was on 15mg for 4 weeks felt good 12.5 for 4 weeks, reduced to 10 felt pain in back and thighs coming back slightly,stayed on 10 for 6 weeks then 6 weeks on 9. Now I'm on fourth week on 8 pain in rib cage and thighs worse,pain comes and goes. Has anybody had same rib pain and I appreciate hearing other people's guidance and advice.

Thanks

[PMRpro Ambassador in reply to Jizer]

Yes - I've had the rib pain due to MPS. It improves at higher doses of pred but returns as I reduce. There are other ways of managing it - I rely on my physiotherapist when it gets bad - but it is caused by the same inflammatory substances as PMR, just they are localised to form the trigger points whereas in PMR they are systemic, all through the body. Sometimes I get steroid shots to reduce the trigger points and allow the physio to work on the spasmed muscles.

But you don't seem to have grasped what I was trying to convey: you have reduced too far - once the pain reappeared at all it was a sign to slow down. You should probably have stayed at 10mg for much longer - pain that returns and stays the same isn't a great problem, it could be something besides the PMR. But when it starts to increase you are allowing the symptoms to flare up because the dose isn't enough to manage the inflammation.

[pmrkitty in reply to Jizer]

Hi, everything PMRPro said in her reply is the best info you're going to get. I have had the rib pain and it was diagnosed as costochondritis. You probably need to go back to 9mg. and see if that helps you. I would suggest after your pain gets under control you reduce by 1/2mg and stay there for a month. Then if you're not having breakthrough pain reduce another 1/2 and so on. If you are having any breakthrough pain do not reduce! This is a very difficult disease to control and it takes a long time, if ever, to get over. I'm sure there will be others coming along with advice. But PMRPro is one of the people on here with the best advice. Just because we don't like what is being said, doesn't make it any less true. Hang in there, you are going to need a lot of help getting through this and I'm glad you found this blog. People on here are very quick to try and help. Hope you gets your prednisone straightened out and get out of your pain as much as possible.

[Telian]

PMR's reply says it all - you've reduced too quickly. Best wishes.