Avascular necrosis

[lyndamcw]

I have PMR AND G CA diagnosed three years ago I am presently on 9 mg and trying to reduce.. I now have a crack under the head of femur and avascular necrosis of head of femur most likely side effect of steroid..due for total hip replacement in June.. My problem apart from the terrible pain and being on crutches for two months is that I have dreadful fatigue.. Not sure if I should increase the steroid dosage to try to combat this? I am 72 but was relatively fit until all this kicked in... Anyone been there got the t shirt that can offer advice? I feel mentally and physically exhausted.. My CRP has returned to normal and ESR is 20.Any advice very welcome. THANKS

[PMRpro Ambassador]

You really must discuss that with the doctor. But I can assure you - constant pain can cause awful fatigue!

[Soraya_PMR in reply to PMRpro]

Quite.

Plus you don’t want the surgeon to not do the surgery due to higher pred. Some of them can be fussy about pred levels.

Do you have good analgesia?

[lyndamcw in reply to Soraya_PMR]

The analgesia does not seem to work as the pain is triggered by weight bearing.. Thanks for reply

[Hidden]

As PMRPro says this is really a question for the Doctors as the Pred is likely the reason for the Avascular Necrosis & maybe Pain Meds may be more appropriate.

Good Luck with your Surgery 🍀 & let us know how you get on.

Kind Regards

MrsN

[lyndamcw in reply to Hidden]

Thank you

[piglette]

As the others say you need to talk to your surgeon. Mine was paranoid about pred and wanted me down to zero before my hip op, in the end we negotiated on 5mg. Pred can theoretically slow down wound healing time which is why they prefer a lower level. I actually reduced before my op to 5mg. Does your surgeon know you are on pred?

[lyndamcw in reply to piglette]

Yes he seems OK with 9mg...let's hope he has read all the info!!

[piglette in reply to lyndamcw]

Best of luck with your op.

[HeronNS]

I doubt more pred would help your fatigue as currently you are slightly above the normal amount the body makes anyway. Plus, if you have not been taking any other medication(s) which can cause avascular necrosis, pred, as you yourself indicate, is quite possibly the cause and you don't want to take any more than you absolutely need for PMR inflammation control. Has your doctor run other tests, iron, electrolytes, other things which if deficient or out of balance can cause fatigue? And are you allowing yourself to recover with a period of rest after each period of activity, even pleasant activity like socializing with friends?

[lyndamcw]

I know I am not good at the rest bit but I agree even socialising leaves me tired out. Thanks for reply

[Bailybiscuit]

I had Avascular necrosis in my hip. I had a new hip and my surgeon was happy to do the operation with me on 20mg pred, but I know a lot won't. I also healed as normal and had no problems. I hope you find a surgeon who is like that one.

[Dream21]

I would ask your doctor. For me, exhaustion has characterized most of my journey due to PMR, GCA, and FIBRO. When I reduced below 10 mg, I was extremely exhausted.