1st Rheumatologist appointment and instructions etc.

[Joan-E-D]

After two and a half years with PMR, my new GP referred me to a rheumy, to get a second opinion she said. I had the appointment last Thursday and was told by the rheumy that it was because I wasn't decreasing my pred. fast enough. I have been on 5mg since just before Christmas as I had quite a bit of pain when I tried alternate 4mg/5mg.as recommended by the GP. However I had started to reduce to 4mg using DSNS before I went to my rheumy appointment. He said my adrenals wouldn't start working if I stayed on Pred. and he wanted me to use Methotrexate to reduce faster. I asked for time to try reducing without Methotrexate for a few months. I was shown a graph for my ESR and CRP results which have been within the normal range since I started taking Pred. and from this he said I haven't had a flare so should continue reducing whether I get pain or not and if I get pain to take Ibuprofen. He agreed that I could use DSNS to do this. He has prescribed Omeprazole which he said I should have been taking all the time I was on Pred.and I'm to continue taking Alendronic Acid and Calcichew.

I don't really know whether it would have been better to have accepted taking Methotrexate, as he wanted me to do, or to stick to my idea of trying to reduce Pred. without it, taking Omeprazole to protect my stomach and also Ibuprofen for pain relief if necessary. It seems either way I'm going to be taking even more drugs than I am now.

I'd be grateful for any comments. Thanks.

[PMRpro Ambassador]

I'd be back to my GP - what a plonker... "not reducing pred fast enough"! Hope he gets PMR one day. The "normal" ESR/CRP are possibly only because you are on enough pred. Just slow down the reduction and use 1/2mg steps before getting on mtx.

[Joan-E-D in reply to PMRpro]

Thanks for confirming my decision to wait was right. I'll see what happens when I have my next appointment in 3 months time. I'm waiting for blood test results so I'll need to see my GP for them anyway.

[Oxford8 in reply to Joan-E-D]

I know who I'd listen to! Plonker or PMRpro? No contest!

[SnazzyD in reply to PMRpro]

I scrolled down fully expecting a PMRPro “plonker” comment or similar. I wasn’t disappointed.

My Rheumy was well happy when I got to 5mg as it was suitably low enough to be not too ‘Preddy’. It’s a bit of a shame throwing in the towel and going for Methotrexate at this level before even trying 0.5mg drops.

[PMRpro Ambassador in reply to SnazzyD]

Well exactly - given the downsides of mtx I don't mind them using it for someone like me on a high dose who can't get down. But once they are at a physiological dose - what on earth for????

[Joan-E-D in reply to PMRpro]

Thanks for replying so promptly especially when things are difficult for you and your OH. My best wishes for better health for both of you. I do appreciate what you post.

[PMRpro Ambassador in reply to Joan-E-D]

Keeps me occupied when sitting and resting so I don't get bored ...

[PMRCanada in reply to SnazzyD]

My GP says 5mg is a good goal to work towards as it is a “safe” dose. No mention of trying to get to “0”.

[nickm001]

Others commented on Methotrexate and taper... but I wonder why you got Omeprazole for? It usually is prescribed at much higher dose, and not below 10mg in my experience. At 5mg, it should be plenty to have some food, like yogurt with pred to protect your stomach.

[Joan-E-D in reply to nickm001]

The Rheumy said I should have been taking Omeprazole from the start (I started at 15mg)and I certainly should take it now, especially if I use Ibuprofen. I told him I didn't have any stomach pains when I took Pred. with food as I do. He said people show up with stomach haemorrhages without pain and that's why he prescribed the Omeprazole. I haven't started taking it yet though nor the Ibuprofen. I simply don't understand this obsession with methotrexate and getting my Pred. down faster. Wouldn't my adrenals kick in by the time I am completely at 4.00 mg. or does that happen at a lower dose?

[nickm001 in reply to Joan-E-D]

First whoever suggested you take ibuprofen for PMR is obviously not very familiar with PMR patients, because ibuprofen does not work and long term use may cause damage to your stomach and you kidneys. I would avoid both ibuprofen and that doctor who recommended it :).

As far as Omeprazole you have to decide. I was on it while I was above 10mg and it made me sick ( after 6 weeks) that I had to stop using it .

As far as adrenal glands, they are suppose to wake up at the dose below ~7mg, but it is rather personal. There was one lady that was fine even at 2mg of pred in spite ofher adrenals not working properly. Best to be patient and keep tapering. If you have any symptoms of adrenal deficiency (Extreme fatigue, weight loss, etc) then you can ask for ACTH hormone test.

[Telian]

PMRpro explains it well!!! In her own inimitable way....