Steroids and cartilage regeneration

[HeronNS]

If cortisone injections have to be limited because they damage cartilage, what are the implications for oral corticosteroids and exacerbation of osteoarthritis?

[PMRpro Ambassador]

The injections are intra-articular so the effect will differ - there is a poor blood supply into joints so oral pred won't achieve as high levels. Which should also mean less effect?

creakyjoints.org/eular-2019...

Interesting site - if you click on the arrows each page is a report of a presentation at EULAR 2019 in Madrid.

[HeronNS in reply to PMRpro]

Thanks. I do know that my earlier doses of pred got rid of all my pain, including OA. Now I have a lot of pain again, the worst it's been since PMR developed. A single dose of aspirin makes it all go away for about twenty-four hours! But all nsaids are bad for cartilage so you're worse off if you take them all the time. Sigh. Our comorbidities are very tiresome, aren't they?!

[PMRpro Ambassador in reply to HeronNS]

I decided long ago that if anything under 5mg kept OA pain under control I'd stay there! QOL is my main aim - no point living 10 years longer if you are constantly in pain.

[HeronNS in reply to PMRpro]

Yes, but I won't take aspirin for OA because in the long run it's counterproductive, and it's looking like low dose pred is too. I really don't believe there is a single drug remedy which safely helps OA and those of us who have it need to manage in other ways. But I've been wondering whether the pred has made it worse, hence the post. Not that I'd have been able to make another choice back in 2015, but today I can, as long as I'm sure it's the right choice with reference to PMR, once I'm sure it's in remission.

[PMRpro Ambassador in reply to HeronNS]

I certainly wouldn't choose to take aspirin - but I AM willing to risk low dose pred - especially as low as you are.

[HeronNS in reply to PMRpro]

As low as this doesn't work. I only had no OA pain when I was above, say 8 or 9. Ever since then it's been a bit of a guessing game which is OA and which PMR although for a while it seemed easy to tell the difference. Still, it is what it is, and although I have pain I can still do things like get out of bed without difficulty, and all the other things which untreated PMR affected. OA tends to flare up in joints then it goes away after it's done its damage, so what I'm thinking may be happening is for whatever reason, maybe pred, maybe it would have happened anyway, it's much more widely distributed at the moment in joints that never hurt before. Will discuss with doctor to try to determine whether my diagnosis is right!

[PMRpro Ambassador in reply to HeronNS]

You mean you have joint pain intermittently?

[HeronNS in reply to PMRpro]

No, unfortunately pretty much all the time. Except the other day after I'd taken aspirin for headache the evening before. And it feels good to be wrapped up a little too warm, and bad when I get chilled.

[KellyInTexas in reply to HeronNS]

This makes me very sad. Warm fuzzy socks and hot peppermint tea...

and fuzzy soft gloves that feel like cashmere socks with fingertips exposed for typing.

A colleague gifted a pair to me and I love them. I keep them by my bed. Easy to hand wash and air dry.

[altywhite in reply to HeronNS]

Luckily I don't suffer too much with my hips, but I have developed osteo arthritic hands and they are painful! I have nodules on 3 fingers on my right hand and just one on my left. The worst ones are my right index and pinkie fingers, some days I can't do anything with them. On those days I take paracetamol which will just take the edge off. My husband keeps telling me to go to the GP and see what he can give me...but I feel there is nothing. I am on 6.5mg of pred at the mo, just got down to that so will hold steady for a couple of weeks.

[PMRpro Ambassador in reply to altywhite]

Have you tried heat? One lady I know has a wax bath and says it helps loads. She was referred to physio or maybe OT I think and they suggested it - and which waxbath to buy for herself.

[altywhite in reply to PMRpro]

Not heard of that, I'll investigate. Warmth is good, it's so sore if I get cold. I might look into the cashmere gloves too 😊 Thanks.

[HeronNS in reply to altywhite]

Luckily so far my hips are fine, but my hands and feet are not, my knees are getting worse and my shoulders have been giving me grief for a long time, one thing after another so now I wonder whether OA is setting up shop in them as well. I also have quite a lot of OA in parts of my spine including neck.

I actually do not believe there is a really safe and effective treatment for OA, at least not known by standard medicine. All the effective painkillers are ultimately damaging and make matters worse, and anyone who figures out how to properly stop, not just slow down, the progression of OA will win a Nobel prize!

[altywhite in reply to HeronNS]

You wonder what's going to happen next don't you. I will take ibuprofen if I'm desperate....and with a big meal, but it really doesn't agree with me. It does seem to have worsened the lower I get with the pred though. Hey ho....and on we go!!! 😊

[piglette]

My orthopaedic surgeon said the pred I was taking for PMR had affected my hip so I needed a replacement one. I am not sure if he were right or not.

[suzy1959 in reply to piglette]

I too have been told that the steroids have made my OA worse. My Rheumy disagrees- who is right? Anyway, my OA pain has been constant and pretty unbearable all the time. No pain killers have helped nor did the 11mgs Pred. which I take. The only remedy has been surgery! Only one more knee to go ......

[piglette in reply to suzy1959]

Will you then be bionic?!

[suzy1959 in reply to piglette]

Wouldn't that be fabulous!!

[HeronNS in reply to piglette]

Well we do know that avascular necrosis can be a, fortunately very rare, pred side effect, so why not less dire joint damage?

[KellyInTexas in reply to HeronNS]

Avascular necrosis is very common in Antiphospholipid Syndrome ( APS) - the Primary disease I am dealing with. The blood is hyper coaguable, so does not reach the areas of femoral head, jaw, and feet bone as, most common presentation in feet are ,” March fractures.”

I deal with repeated metatarsal fractures in feet- especially when I was pregnant- when blood is thicker in all women anyway. The added weight didn’t help matters!

I’ve been having a lot more pain in my feet since starting pred and Solumedrol. I have to wonder if I’m hairline re fracturing there old breaks.

There is nothing to be done about it- it just has to mend.