Steroid injection

[tangocharlie]

Has anybody had a general steroid injection (Depro-medrone?) to reduce overall inflammation? I'm looking into options to avoid going back on Pred. I mentioned it at the last rheumy appointment but the doc was shoving me out of the door after 10 mins and just said the dose was only about the equivalent of 5 Pred so wouldn't be high enough for me. Does it have the same side effects as oral Pred eg weight gain? I've had them for shoulders, hip bursitis and feet before but they were into specific areas. Each time they worked brilliantly.

[Tiny_Tim]

Yes..from time to time I would be given a " top up" by my Rheumatologist if I was getting more pain generally and perhaps preparing for an event or holiday . It does give you a lovely boost and lasts for maybe two or three weeks, then its back to the daily pills . It does not change your situation and you still need to take the right amount of medication once the depo wears off . I did not put on weight .

Tiny-tim

[PMRpro Ambassador]

The joint injections work locally. The Depomedrone is different, it is a slow release injection into a large muscle group - buttock or thigh usually - and it releases more at the start and the amount tapers until the symptoms return. They are suggested in the recommendations for the management of PMR:

rheumatology.org/Portals/0/...

Recommendation 5 and there are links to the studies. I think your doctor is just not wanting to play somehow.

I know of someone who used it successfully for GCA to avoid gastric problems and there was a man on the forum who was reporting his experiences using it for PMR - he had done all sorts of graphs about the amount you get on day 1 through to day whatever. Sorry but I don't know how to find it - the search on HU is useless!

They do avoid the gastric issues I think - but corticosteroids are corticosteroids and some of the potential side effects are the same

PS: Google triumphs!! The Admiral's post:

healthunlocked.com/pmrgcauk...

The rest of his posts are here

healthunlocked.com/user/adm...

And this link talks about side effects?

rxlist.com/depo-medrol-side...

You must remember that PMR is a systemic disorder, i.e. all through the body, and so the corticosteroid, whatever is used, must also get throughout the body. The potential for adverse effects remains, even if they vary a bit. I take 15mg prednisone - and really can't identify adverse effects.

[tangocharlie in reply to PMRpro]

Thank you so much for the spot-on information PMRpro. My problem is I'm so sensitive to weight gain with Pred. I took a dose of 10 Pred for 3 days recently and put on over 2k/5lbs instantly, and that's even though I do a low carb diet with no sugar or alcohol. I just don't know what to do.

[GOOD_GRIEF in reply to tangocharlie]

Gee, that sounds more like water weight than piling on the fat. I don't want to scare you, but there could be other reasons for that kind of weight gain, and you really need to report it to your doctor.

[tangocharlie in reply to GOOD_GRIEF]

Thank you, I've been investigated for all sorts of things including heart failure as I have peresistently swollen feet and ankles and every test comes back clear. I've been in my GP surgery so often everybdy knows my name!

[GOOD_GRIEF in reply to tangocharlie]

Have they checked your kidney function?

[tangocharlie in reply to GOOD_GRIEF]

Not sure, will ask, thanks

[PMRpro Ambassador in reply to tangocharlie]

As GG says - that is almost certainly fluid retention if it is that fast. Salt restriction may help there.

However - our local hospital knows us as friends!! It DOES have some positives...

[Linny3 in reply to PMRpro]

Very interesting reading. Many of us divide our dose. This is what the study says about that.

Recommendation 6: (PICO 8) The panel condi- tionally recommends using a single rather than divided daily doses of oral GCs for the treatment of PMR, except for special situations such as prominent night pain while tapering GCs below the low-dose range (prednisone or equivalent ,5 mg daily).

There are no studies available addressing this issue specifically in PMR. Based on clinical experience and because of the concern that adverse events (includ- ing disturbance of the hypothalamic–pituitary–adrenal axis) may be higher with divided doses, the group agreed against the general use of divided GC doses in PMR (40–43). The effectiveness and acceptability of a single daily GC dose has been standard clinical practice in PMR and other inflammatory conditions (44,45) and evening doses can cause circadian rhythm and sleep dis- turbances (46).

In special situations such as in case of night pain while tapering below the low-dose range (prednisone or equivalent ,5 mg daily), split doses may be considered. However, persistent breakthrough symptoms should prompt re-consideration of the diagnosis

[tangocharlie in reply to Linny3]

Yes I read that, my GP also told me not to split the dose.

[Blackcat1M]

Yes I have had three and they worked within a day of having it. I could hardly walk before and found that after a day I was walking almost normal, it lasted for about three months

[suzy1959]

My lovely Rheumy has given me some phials of Depo medrone to get my local nurse to use on me when I have a flare and it means that I don’t have to mess about with my oral dose.

[tangocharlie]

*Update* had 120g Depo-Medrol injection at Wharfedale Hosp Leeds (I asked Dr Dass about it as I stiff have a bit of PMR but didn't want to go back on Pred and he agreed). Was quick and easy. Didn't feel any different for about 4 days then woke up on day 5 feeling nauseous. Took travel sickness tablets and it went away. Since then have felt much more spritely, more energy. No weight gain, in fact have lost 3lbs this week (due to eating low carb diet not a side-effect). Had leg cramps some nights, but don't know if that's due the injection or other things, I used to get it a lot when on Pred. Still have a bit of hip/pelvis pain in the morning, but I think it's better than it was. Am told the injection lasts about 6 months but I'll get another rheumatology check up in 3 months. I'm surprised people aren't offered this as an alternative to oral Pred, I only got it because I asked about it. Still a bit of insomnia and slight increase in appetite, but again not as bad as when on Pred. I think it's roughly equivalent to being on about 5 Pred.

[PMRpro Ambassador in reply to tangocharlie]

6 months seems a bit OTT - depends on the dose and the person. But most people find they last a couple of months.