Hello! I've had PMR and been on Prednisolone for about 5 years. My brother rang me today saying that his GP thinks he may have PMR and has given him a cortisone injection in his buttock and told him that his symptoms should go within a month if it is PMR. To come back and see him then and get a blood test done. Now, I've had my thoughts about this, however, I am impressed that he has considered PMR as a diagnosis because his symptoms sound like PMR to me. The injection was yesterday and there's an improvement. He can move his head easier and he got out of bed with no problem this morning. I'm very aware that the drug of choise is Prednisolone orally. Have any of you had this as treatment for your PMR? What do our experts think? (He also has osteoarthritis in his hips and knees and has had cortisone injections into his joints in the past.)
Cortisone injection for PMR: Hello! I've had PMR... - PMRGCAuk
Cortisone injection for PMR
He should have read the Diagnosis and Treatment of PMR issued by the BSR and also held on the NHS website.
15mg-20mg for 5 days would have shown and I take a bet, he did not do a blood test to exclude Vit D deficiency and get the ESR or CRP results either.
Sounds a bit like 'guess work' to me.
Hope your Brother stays pain free and I am wrong. At the least that injection should help his osteo.
Blood tests in a month! Yes, he was guessing but at least he realised these symptoms were something other than arthritis. Maybe, he's gone and looked it up by now... so you, like me think its the wrong drug? The fact that he can turn his head better and got a decent sleep last night is convincing Gordon that it's working.
Oh my goodness, nayve the doc wasn't so daft after all and it's my brother that's got it wrong! I've just seen another post where somebody is on a form of Prednisolone by injection every month and it's working!
It is deep intramuscular Depot-Medrone injections. It is mentioned in Recommendation 5 here:
rheumatology.org/Portals/0/...
It would be so much less confusing if they called things by their real names and not "cortisone shots" when they mean i.m. methyl prednisolone.
I knew there was another name, as you had told me before. Just could not think of it.
I have Dep-Medrol injections, injected into my thigh. Rheumy will only let me have them every 3 months, and then only for another year, but they run out after just over 2.5 months for me. I found the injections have worked better than oral Pred in getting me more mobile and without the weight-gain side effects.
That's the idea. But saying you can only have a limited number is like telling me I can only take a total of 200mg of pred in a month but I need 8mg a day to be pain-free ... Daft. It is intraarticular (into the joint) steroid injections that should be limited - NOT i.m.
Exactly my thoughts. If I was on oral Pred it wouldn't be limited. He (the rheumy) insisted I couldn't have it more frequently but mumbled when I challenged him on what the dangerous side effects were given that I need to take Pred anyway if I still have PMR. He said 'weight gain' and I said I hadn't gained any weight on the injections, but did on oral Pred. He said 'danger of osteoporosis' and I said I'd had a dexa scan and everything was fine. I also pointed out that surely the most important thing is to get the inflammation levels down? I think doctors are just conditioned to think steroids are bad and they must get us off them.
Don't introduce him to me - he'd get an earfull. What stupid logic! Or lack of it!
I wish you'd been there. I'd printed off some info you posted a while ago about how low dose steroids don't cause long-term problems which gave me the courage to argue. At first he said I should only have 2 a year, 3 max. I didn't want to antagonise him too much in case he said I couldn't have any more injections, as they seem to be working well for me compared to the oral Pred, fewer side-effects. Also, on the whole he (Dr Dass - one of Dr Mackie's colleagues in Leeds) is a very good kind Doctor compared to some other rheumys I've seen and has been a very good listener. I guess as the depo-medrol injections are not standard treatment for PMR there aren't any guidelines to go on?
Not sure to be honest. Will try to find out.
This is Dasgupta's original paper on using i.m. steroids:
watermark.silverchair.com/3...
They did injections every 3-4 weeks over 96 weeks in the study - so obviously DrD has never read that.
You could show him this and see what he says. His excuses are negated directly - the cumulative dose is far lower with i.m. and therefore likely to be associated with less risk of osteoporosis and other adverse effects
Thank you for link!!!
I’m in the throes of this right now.
Link in timing out- sorry for inconvenience. I’ll simply google the doctors name with the relevant topic.
My hips are fine- shoulders fine. Cervical spine is not, but often seen with lupus/ APS/ connective tissue.
The IM solumedrol every three weeks is the only thing really helping me not clot. ( other than warfarin- but that’s obviously only a part of the picture in my case.)
I think I’m getting blasted too high a dose- then letting it go to zero. When I have symptoms I’m to go back for another injection. This Yo Yo is not ideal.
I feel slow and steady will be better.
I’ve been told- don’t worry- it’s only for three months until we get IVIG approved.
This solumedrol is working better than the Rituximab ever did. It’s because it’s keeping the vascular swelling and subsequent clotting at bay.
This is a link to the Abstract
ncbi.nlm.nih.gov/pubmed/956...
At the bottom is a DOI number link - which brings up a page saying it is only available as a PDF but you can download it.
Just been playing to find it - and my brain hurts!
Thank you so much for hurting your brain to do this!
The last sentence is very encouraging- “ for other rheumatic diseases as well.”
The 5 mg pred orally is not nearly as effective as the IM 80 or 120 mg. It lasts about 10 or 20 days depending on strength.
I will take a morning 5 mg oral tablet of pred if I break through on a weekend and can’t get in until Monday morning for an injection.
Ive lost muscle tone in this process. Ive been getting these injections since early May.
Interestingly - a top PMR rheumy says she uses i.m. depotmedrone for other things but not so much for PMR. Which does seem strange. There are things where I disagree with Dasgupta - but sometimes he does have some excellent ideas.
Thank you PMRPro, very useful. Yet again I'm battling against the ignorance of doctors, it's so frustrating! Maybe just because there is a paper published doesn't mean news filters down. Though I find it scary that the experts we trust are often wrong.
I'm not sure I'd call it ignorance - habit more. And most patients would get quite iffy about monthly deep i.m. injections!! I have started to explore the question with that rheumy - and will try to "get at" one here who isn't influenced by UK habit but who worked with Dasgupta.
I think it's fair to say someone is ignorant when they emphatically tell you wrong information when they ought to know better.
I followed a link on the article you found to another article on Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica from 2015 ncbi.nlm.nih.gov/pubmed/263....
In the Abstract it says the IM depot medrol it could be advantageous over oral Pred as sparing some of the side effects. It refers to 'a comparable efficacy of intramuscular methylprednisolone and oral glucocorticoids (GCs) with lower cumulative GC doses and less weight gain in the former group'. If this knowledge that the IM injection is effective and has fewer side effects than oral Pred has been around fo rmany years, why have we not been given that information and choice? I wasn't offered it, I had to persistently ask for it.
I've just seen the date on that, 1998?! Is that right?
Dasgupta's original work? Yes. It's been in the public domain for 20 years - but no-one has thought to do a study on using a different form of pred. But they bang on about steroid-sparers that there is no more evidence for than for just using injections and add adverse effects rather than reducing them. I imagine some of it is getting funding to do a study and maybe they expect there to be patient resistance. After all, who likes injections?
Top PMR specialists are aware of the seminal paper - so why don't they look more closely? But you are right. If you know it can be done - please check the facts before telling the patient who wants to have that approach a load of crap.
The injections are not really painful as they go into the thigh muscle, you just feel a slight scratch and slight ache but it's only for a few seconds. For me, side effects have been fewer and lesser with the injections, not had any weight gain, no moon face, no insomnia, less brain fog. And I think I'm much more spritely with less ankle swelling and more arm and shoulder movement. I think, but am not sure, you also don't get the problem with adrenals having to start up again - I had horrendous problems getting below 5 with oral Pred. At one point I was prescribed methotrexate and azathioprine which both had terrible side effects for me, after all it is like having chemo isn't it - but there was no mention of the depo medrol option. I've had a catalogue of bad treatment over 7 years.
It should be easier - because by the end of the period you are down to way under 10mg/day. Admiral6 (or is it 06?) did an epistle about it. You are permanently tapering to a lower dose.
The others I knew had bum injections - couldn't do their own as a result. I was on oral methyl pred for a while, horrible. I have no problems with oral prednisone as Lodotra. mtx was horrible too! No-one's mentioned anything else. Tocilizumab was mentioned in passing but we'd have to apply for permission and at the price would they let a furriner have it!!!
Look further down this conversation for a link to the Abstract and from there you can access the PDF
I was given the same deep slow release injection at the outset. The Rheumatologist said if I felt like a new woman after 48 hours then PMR would be the diagnosis and I did. It started to wear off after about 12 days and I have been taking oral conventional Pred since my second visit to the Rheumy 5 weeks ago.
Same here . Only lasted a while.
i was given another shot of Depot Medron in both hips end of July by Rheumy, was in constant pain for 5 weeks then woke one morning and it had gone. Still on 8mg pred and have not reduced until everything settled. First set of shots I had pain for 2 weeks and then fairly painfree for 3 months. I've also had shots in both shoulders which was very effective. Not sure if I'll have injections again. I think I would be better increasing to 10mg and then tapering again but Rheumy very anti any increase. Should be on 6mg by now according to her advice at last appointment. Tough! Also got serious problem with teeth, like many others. Several have crumbled away and need to be extracted from gums. I presume I will be referred to dental hospital for extraction .
Injections into the joints are not the same as the deep i.m. injections used for management of PMR. It is the positioning in the large muscle that makes the difference.
I read in a few articles that PMRPro referred me to, that in the early stages of PMR the injections would have to be repeated about every 3-4 weeks initially.
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