The lesser of two evils, Prednisone vs Naproxen?

[Loco99]

I have had PMR for about six years and take 5mg of Prednisone a day, I have painful knees and my GP has diagnosed OA and prescribed Naproxen which at this stage I only need to take occasionally.

I think my PMR is on the way out but my knees are gradually getting worse so I should really start to taper my Prednisone dose but no doubt my knees will get a lot worse (due to the loss of the Prednisone) and I will end up taking a lot more Naproxen instead.

I would prefer a relatively low dose of Prednisone plus the odd Naproxen as opposed to a daily dose of Naproxen am I correct in thinking that Naproxen will do more damage in the long run than Prednisone?

[Hidden]

Hi Loco

I have bad knees so can sympathise with you. Remaining on Prednisolone to keep the OA at bay is not the way forward.

Long term we cannot say which drug is better as we are not Medics but taking Pred with the implications of that long term would not stack up well against an Anti Inflammatory in my book, they certainly don’t cause a moon face or weight increase, they can be stopped at anytime & replaced with another Medication.

If your PMR is receding, then lower your dose accordingly, there are different types of Anti Inflammatory Medications, some that only need to be taken once a day, with a meal to help protect your stomach. Most people who are on Anti Inflammatory Meds generally take a stomach protector as well.

Best Wishes

MrsN

nhs.uk/conditions/osteoarth...

[Yellowbluebell in reply to Hidden]

I agree with mrsnails here. Husband has taken naproxen for 10 years twice daily and has no side effects. He does take a stomach protector. He has said he would prefer his drug cocktail to my pred!!

[Hidden in reply to Yellowbluebell]

Wish l was just on Diclofenac & omeprazole, those were the days!

[Yellowbluebell in reply to Hidden]

OH used to take diclofenac before his neuro surgery but it didnt relieve the pain afterwards. He takes omeprazole with his cocktail of pain killers but has never had any side effects from any of them thankfully. No one has suggested he might be susceptible to osteoporosis, but then again hes never been told about side effects of any of his drugs!!

[Hidden in reply to Yellowbluebell]

They stopped my Diclofenac a long time ago now, l have Meloxicam for my knees when necessary! Thank You Chemo!

[Yellowbluebell in reply to Hidden]

Does it work better though?

[Hidden in reply to Yellowbluebell]

The Diclofenac worked when l took it but wasn’t on a NSAIDS after l started Prednisolone but once my knees started to show the damage caused by Chemo they prescribed Meloxicam which is great as it’s also once a day!

[HeronNS in reply to Yellowbluebell]

Some of the stomach protecting drugs can promote the development of osteoporosis.

[sennetta in reply to HeronNS]

And cause kidney failure!

[PMRpro Ambassador]

You cannot know "the PMR is on its way out" if you are still at 5mg - if it is then you should be able to reduce below 5mg. It isn't a case of which is better, it is horses for courses and which achieves the required result for the underlying cause.

If you take stomach protection with the naproxen you should be OK with a low dose of pred.

[HeronNS]

Nsaids interfere with cartilage regeneration so you should not take naproxen, or even aspirin, regularly if you have osteoarthritis. For some reason I learned this when I was first diagnosed, long before google provided the answer to all questions, so I stopped taking the coated aspirin which was what was suggested at the time. I'm talking over thirty years ago. Instead I have made sure I take a fairly large dose of glucosamine every day (two 500 mg capsules - not tablets - twice a day with a meal). I also read that Vitamin B6 would be helpful, but not wanting to take only one B vitamin I take a B complex pill, nowadays I take one of those every second day. Although I do have fairly extensive OA in various joints I think there has been remarkably little progress of the disease over the past few decades. I only take nsaids (usually aspirin as naproxen was too hard on my stomach) for headache, never for OA, although when I do this the other aches and pains are also helped. Of course my initial dose of pred took care of everything!

[Hidden in reply to HeronNS]

What else would you take for OA Pain especially if it was chronic?

[Hidden in reply to Hidden]

I have found this link. Not sure how useful as exercise, weight loss, and dadaa, spa treatments are mentioned. But no skiing or playing football where you might twist knee joint 😜😖😉 Something I didn't realise(if it's true) is that 1lb of weight loss equals 4lbs of " pressure" on knees.

arthritis.org/living-with-a...

[Soraya_PMR in reply to Hidden]

Yes I believe weight loss is the single most important thing to aid wonky joints, including the spine.

More than 4x depending on the activity.

health.harvard.edu/pain/why...

(Not something any doctor has ever been able to tell me to do....oh yes, there was one doctor at the Family Planning Clinic who ‘heard’ my weight, and declared before seeing me “You need to lose weight!” I walked into his consulting room and stared at him from my 6’1” height. “I take that back!” he said. Idiot.)

[Hidden in reply to Soraya_PMR]

😂😂😂

[Hidden in reply to Soraya_PMR]

I have had back issues since a motorcycle accident when I was 17yrs old. Then at 19, I was so scared of the Yorkshire ripper (I lived 1/4 mile from where a victim was found). I wasn't looking when I jumped out if the car, stepped down a kerb trying to run to my front door in a crash helmet and my back made the loudest popping noise I had ever heard. I was off work 3 months, ironically at the ripper incident room. I was about 8st wet through and my back has been no good ever since.

[Yellowbluebell in reply to Hidden]

I used to worry about the Yorkshire ripper as well. It was a scary time for young women

[Hidden in reply to Yellowbluebell]

Especially when you have examined the post mortem material!

[Yellowbluebell in reply to Hidden]

I hadnt decided on law as a career at that stage. Was just in my late teens. It was one of those cases amongst others that made me become a barrister. Strange thing was I didnt like criminal law that much!! I just remember being in my early teens when he started and my dad wouldnt let me go anywhere without being dropped off and picked up!!

[Hidden in reply to Yellowbluebell]

I suspect my mum and dad worried a fair bit too.

[mrsQuics in reply to Hidden]

gosh re ripper

[Thelmarina in reply to Hidden]

How horrible - you poor love 😕

[PMRpro Ambassador in reply to Soraya_PMR]

Preconceptions ...

[Thelmarina in reply to Soraya_PMR]

😂

[Hildalew in reply to Hidden]

Thank to you, Poopadoop, for that mention of 1lb = 4lbs - and to you and Soraya for supplying references. It was a much-needed reminder to me of the significance of weight in the whole complex business of 'wellness'. I was already obese when I was diagnosed with PMR and though annoyed about the 7lbs or so that I acquired when I started on Pred (for PMR) 6 or 7 months ago there were SO MANY things to deal with, psychological as well as physical, that I didn't adopt any conscious regime to deal with it, especially as it seemed to settle down at the new weight. So I have tended to disregard the occasional knee twinges. Your reminder has come at a time when I am managing myself and my Pred fairly well. I should be able to get myself a little bit more thoughtful about my food intake and my exercise.

[HeronNS in reply to Hidden]

Nothing. I do my exercises to maintain range of motion. I keep warm. I live with it. In fact when I started to sicken with PMR I thought it was the OA getting worse, and eventually was asking my doctor for a pain medication. She prescribed Celebrex, which I think should be taken off the market, and I never took it. When I started pred for PMR it really did get rid of all my aches and pains, but the OA and other stuff returned when I dipped down to lower levels. Not sure exactly what dose where I figured I'd better keep tapering because the pain was "only" the OA, which I'd kind of forgotten about. My worst sensation is my hands and feet, and I have had back problems, often referred pain to hips. No OA in hips. A bit in knees and was told the OA iin my left knee, the broken leg knee, would get worse because I'd had the fracture. My physiotherapist is a miracle worker.

[Hidden in reply to HeronNS]

Wow! The pain in my knees would be unbearable without Meds, they are not so bad at the moment as I’m on higher than normal Pred.

I’ve had knee issues since l was 6years old & surgery on them at 16&17years old but l now have numerous aches & pains in my joints & bones aside from my PMR.......

Take Care

MrsN

[HeronNS in reply to Hidden]

I've always had bad feet. The hands were what got me the diagnosis when I was 40. No surgeries, which probably makes a difference. And I'm now very thin, so light loadbearing for the lower limbs!

[Soraya_PMR in reply to Hidden]

I’ve been told that opening a joint (as in surgery) will almost inevitably result in arthritis at some point in the future. One of the reasons I declined arthroscopy on my knee cartilages.

[Hidden in reply to Hidden]

I used masons dog oil for a while and it helped in general. I suspect though that the act of massage is itself the helper.

The other thing that is recommended by some pain clinics for OA is LOWER dose capsaicin cream. I hesitate to to recommend it as your legs seem sensitive. (Tens) However i found the low dose Zaicin 0.025 helped bursitis/OA in my knee and I was fine until they bunged the dose up to the axsain 0.075 because it was "better value" on prescription. It was just too strong for me.

If anyone uses it please put a glove on when applying. Even if you wash your hands after applying it can burn your eyes and lips. I am putting it up with the please be careful proviso. And use less than recommended pea size lump on the first go.

hey.nhs.uk/patient-leaflet/...

[PMRCanada in reply to HeronNS]

Wait, what??

I took 1000mg if coated Naproxen for 5.5 months prior to PMR diagnosis. It helped a bit, but the unchecked inflammation ran wild until I started pred. My GP advised me to stop Naproxen when I started pred, but no one ever advised me that NSAIDS interfere with cartilage regeneration. After my PMR diagnosis I had an MRI of both knees, they are a mess and I have OA in right knee and am awaiting a total knee replacement. 5mm of bone-on-bone contact as of June/18, and last visit from surgeon advised from X-ray deterioration more rapid requiring X-ray every 6 months.

Now wondering if it was a combination of being overweight/inactive, unchecked PMR inflammation (my knees were symptomatic first), and all that Naproxen I took that deteriorated my knees so quickly. Before PMR I sometimes got one sore knee after walking lengthy distances, but never the pain I have now (especially as I lower my pred dose). I could dance, walk, even play tennis. Now I wait......and wait for a total knee replacement. (sigh)

I will be asking my GP for some pain medication for my knee pain when I see him in July. I don’t want the emergence of other mechanical joint issues and pain to interfere with my taper. I’m hoping knee surgery won’t interfere either. Sometimes it’s a challenge sorting it all out. Is it PMR, pred withdrawal, DOMS, stress, other organic health woes??

[HeronNS in reply to PMRCanada]

My doctor recommended the aspirin to help with the discomfort of OA, and suggested coated version to help with stomach. Obviously he didn't know about the cartilage regeneration. When this subject came up a few times on the forum I looked it up to make sure I wasn't misleading people, and I am not, it is true. It was sheer luck that I read about it when I did.

[Hidden in reply to HeronNS]

I have just been reading about it since you flagged it up. That is scary. I can't remember if it's on the patient info leaflet and haven't had any for a while.

[Hidden in reply to Hidden]

Just looked at an online ibuprofen patient information leaflet. No warning - despite connections being made since at least as far back as '93. That is way more scary than pred was to me.

[GlynisE]

Naxoprene is fine for an occasional dose but before my diagnosis and prednisone I was taking it twice a day. It made me incontinent. Terrible. I think what you are doing now is best.

[Kaaswinkel72]

I would choose naproxen any time if that works for me instead of prednisone. OA knees need an anti inflammatory meds. Not prednisone. You might have to get used to it though. Alida

[PMRpro Ambassador in reply to Kaaswinkel72]

Um - and what exactly is pred except an anti-inflammatory med? NSAIDs are NON-STEROIDAL anti-inflammatories. And I would take a couple mg more pred instead of an NSAID any day.

[Kaaswinkel72 in reply to PMRpro]

You are free to take what you want or advise to an other person when asking for an opinion, and so am I. Alida

[SusanEleven in reply to PMRpro]

My rheumatologist said she’d rather see me go up a little on prednisone than to take the daily NSAID I was using for my OA.

[Thelmarina]

Thanks for opening this thread. Really interesting and in its own way a plus for Pred! In that it keeps other aches and pains at bay until the lower dosages. I now have a honeymoon feel 😉👍 (but I am prepared..)

[jinasc]

Try Flexiseq..................I have used it for OA for nearly three years. No pain, no side effects either as it is a bio-mechanical gel and the only way I can describe it is that it works like WD40.

Go to the ARC site (research section) and read up on it.

Left Knee OA, Right Knee Bone on Bone - no pain in either with Flexiseq.

Thank goodness Arthritis Research and a German Pharmaceutical worked go together.

Not cheap and not available on NHS but worth every penny, try a tube.

[Soraya_PMR in reply to jinasc]

Hubby says it’s worked for his hands but not his knees. Hasn’t helped my hands. But definitely worth a try, I’ve read lots of reviews and many people benefit from it apparently.

[jinasc in reply to Soraya_PMR]

I found that although it said, use for knees, as you had to sit for 10 minutes after putting it on, my hands did not get washed for those ten minutes. Fingers work better than ever and the two which caused me pain..............zero pain.

If I get bone pain anywhere else...............I am going to try it................but I have to laugh, as I think it would take a whole tube for my hip. 😉😉

Anything that I don't have to swallow, is worth a try.

[Soraya_PMR in reply to jinasc]

I’m all for drug free solutions where possible 👍🏼

[daworm]

My knees are in bad shape also, I’m at 5mg of pred and since tapering down all my OA symptoms have gotten a bit worse but pred probably isn’t the way to go for OA...I use the occasional 600mg of ibuprofen which seems to work better for me than naproxen...also use occasional Tylenol along with the ibu on a bad day...doc said they work with each other..I’ve had meloxicam (Mobic) as a prescribed anti Inflammatory Medication but don’t like it...

[davidem]

I’m not a GP and have no qualifications except ‘life’. I had to go on naproxen and to cover me my GP gave me Omeprazole but it did not stop the the naproxen chewing my stomach. For me it was poison!

Again for me I know Prednisolone and sort of understand it . . . . in fact it’s my friend but naproxen (no way).