Am I having a flare?

[mtrafter]

Thank you for all the supprt you give to us all, I have found the forum invaluable

Was diagnosed 2yrs ago, I have not ever had a flare so am unsure if the following symptoms constitute a flare. I have been reducing using dead slow method , tried to get to 5.5 mg but couldnt maintain it, have been at 6mg for 4wks, initially no problems, over the last week have had a very bad cold and cough, on the mend now but have pain and stiffness in my arms and neck unrelieved by 6mg. But more concerning I feel whoosy and lightheaded, vaguely nauseous and am having intermittent palpitations. I increased pred by .5mg at 2pm and have some relief of pain and stiffness, but not the other symptoms. Would appreciate any suggestions.

[SnazzyD]

Sounds like it could be you need more Pred for your body’s illness stress and your adrenals aren’t helping with this extra load. My Endocrinologist said to double the dose for illness when down to around 5mg and below. If you are someone who doesn’t absorb 100% anyway, that stage will occur above 5mg. You’ll get some good advice soon but if it was me I’d do a 8-10mg for a couple of days and see if the horrible feeling goes. If it doesn’t improve quickly, especially the palps then see a doc.

[mtrafter in reply to SnazzyD]

Thank you SnazzyD for your thoughts, I think you might be right that I may not absorb 100% of pred, as before my current illness I was aware of the discomforts of PMR returning around 4pm! Looks like I need to increase the pred a bit more to see if I get more relief.

[jinasc]

"But more concerning I feel whoosy and lightheaded, vaguely nauseous and am having intermittent palpitations".

You need medical attention, A&E or GP first thing tomorrow morning.

Never ignore all those symptoms plus intermittent palpitations, ................I did and ended up in A&E and a two day stay in hospital..............lesson learned.

[mtrafter in reply to jinasc]

Thanks jinasc I certainly do not want to end up in hospital, if things dont improve tomorrow with an increase in pred I will be off to GP for review.

[PMRpro Ambassador]

I suspect that, as well as being at the limit with regard to low dose managing the PMR symptoms, your adrenal function is lagging behind the reduction - and your infection has asked a bit much of what function is there. If you had been diagnosed with poor adrenal function you might have been told to boost the pred dose by a bit during the infection - not sure what the "sick day" rules are offhand though.

Like Snazzy, I'd try maybe at least 8mg for a couple of days - and get an urgent appointment with your GP. I have had palpitaions due to atrial fibrillation for some years but last year they got worse at lower doses of pred and I have had both tachycardic (fast) and bradycardic (slow) episodes which make me feel as you describe. It is due to the autoimmune part of PMR and has recently finally resulted in me needing a pacemaker - it is worth getting the palpitations investigated since they have appeared at a lower dose of pred, when you would expect them to be improving if pred caused them which is what most doctors choose as the reason!

[mtrafter in reply to PMRpro]

Thanks so much for your insights PMRpro. Looks like I have not had enough pred onboard to cope with my recent infection I should have increased it earlier! lesson learnt. I will, up the pred to 8mg for a few days and see how I am, if pain and stiffness improve but palpitations continue I will see GP for review.

This illness is certainly a rollercoaster ride, one minute all is going fairly well and then wham! Surprise slmethi g else to cops with🤔

[jinasc in reply to mtrafter]

PMRpro wrote "and get an urgent appointment with your GP"

That does not mean you do not go to the GP tomorrow, it means an urgent appointment tomorrow. .

[mtrafter in reply to jinasc]

Tomorrow is a Public Holiday in Australia, my GP clinic is closed, would prefer to see someone who knows my history but if the symptoms persist I will seek out emergency clinic appt. Otherwise will get urgent appt for Tuesday with my GP clinic.

Thank you for your concern.

[dancersize in reply to mtrafter]

The cold weather we have had here in Oz lately probably hasn't helped. Did you get a flu injection? My GP said I should so I did.

[Blearyeyed]

Increasing the dose during illness when you feel rebound pain and for a week to two after can usually be helpful .

That increase for a short period can often be tapered back down to the managing dose you were on quicker than the usual taper.

I am concerned that you have other symptoms going on there too though which may have nothing to do with PMR related symptoms or current medication .

You are likely to be having a mini flare of PMR pain because you were ill and needed extra Pred , but it could also be pain related to nonPMR symptoms.

Especially if things like palpitations and dizziness are not side effects you experienced before. These are symptoms that should always be checked by a Doctor.

My advice is keep to the increase that you are finding helpful but make a GP appointment as soon as possible to discuss these new symptoms and have them and their cause checked properly.

Please let us know how you get on , take care , Bee x

[mtrafter]

Thanks Bee for your thoughts. I have not experienced dizziness or palpitations as side effects before. They are a little worrying if they are not related to pmr! I will certainly be getting them checked out if they continue.

I will let you know how I get on.

[HeronNS in reply to mtrafter]

Go ahead and make the appointment. I know you want to wait and see if an increased dose, and your cold improving, will help, but your doctor really needs to know about these symptoms while you are experiencing them. Let us know how you get on. All the best.

[Blearyeyed in reply to HeronNS]

Especially as you can't be sure how long you may have to wait for the appointment from the day you ring up anyway.

Even if the increase works , still go so you can update the GP on the new symptoms as they still may need to be checked out .

It is good to keep them updated on new things going on in case it happens again , it's on your record , so they no its ongoing issues and not new , shows them were to evaluate their diagnosis from.

[Thelmarina]

I do agree with the others and that getting medical support is vital with these symptoms. I think the illness combined with Pred can slow down our normal responses, so sometimes we miss the significance of our own symptoms and almost don’t have the energy to deal with them. Get to that GP or clinic on Tuesday and please let us know how it goes.

[dancersize]

Just looked back at your history. What is the past condition you also had with different medication for? PB? Did you go on to the methotextrate? I started on it in Jan because I couldn't get below 6mg and I've managed to reduce to 3.5 but I have sometimes felt lightheaded and a bit nauseous while on MTX.

[mtrafter in reply to dancersize]

Hi, I also have auto immune liver disease - Primary Biliary Cholangitis .My Rheumatologist wanted to put me on Metheltrexate to help reduce faster off pred but after more tests it was decided not to put anymore pressure on my liver. So between my GP and myself we are on a very slow taper down. Im starting to think that maybe my recent infection has somehow thrown my whole system out of whack as my BP which is usually on the high side of normal is currently lower than normal. Hopefully I can get urgent GP appt tomorrow and get some answers.

Thanks for your interest.

[PMRpro Ambassador in reply to mtrafter]

Low BP would also account for those symptoms - and could be associated with the adrenal function.

[mtrafter in reply to PMRpro]

I have GP appt tomorrow and fortunately my 6mth appt with Rheumatologist is due next Monday so hopefully we can sort it all out.

[MamaBeagle]

I had palpitations and light headedness a couple of months ago. I couldn't account for it but the boom boom of my ticker doing a rock 'n roll scared me a bit. I got a same day appointment with doc who listened to my chest and said if it wasn't boom booming he'd be more worried!!! He couldn't account for the light headedness but sent me for blood tests and an ECG......all fine. In fact I started to feel better as soon as he said ticker sounded fine to him......hope you have the same result!

[mtrafter in reply to MamaBeagle]

MamaBeagle It is certainly is a bit concerning thank you for sharing I hope I have the same outcome as you did.

[Noosat]

I found if I split my dosage, down to 4.5mg, taking in early morning and evening that I did some better in tapering. Also the supplements I take, which are a multi vitamin, magnesium, calcium with vitamin D, all at different time periods during day, I seem to feel better

[mtrafter in reply to Noosat]

Hi, I thought once I get my current situation sorted I would look into splitting my pred dose I might get better coverage across the day. I hate feeling so unwell, I've been fortunate that I have had a fairly smooth run with my pmr journey.