Do I stop prednisolone?

[albatross]

I have been on prednisolone for 11 years, tapering down then up again. Now on 5mgs. I have had a new knee, a plate and screws in my left foot and 2 new hips with so much pain I don't know where I am! Could the steroids be causing my joint trouble? They have said don't stop because of all the stress. I don't know what to do and although my doctors are very good don't know much about PMR.

[PMRpro Ambassador]

No - after 11 years on pred and not below 5mg you MUST NOT stop the steroids suddenly as that would put you at risk of an adrenal crisis which could make you extremely ill and even hospitalise you. Particularly since you are under stress. Please discuss this with your doctors.

[DorsetLady PMRGCAuk volunteer]

I don’t think you can blame Pred for your joint issues per se.

I had OA long before I had GCA, and the problem is that at higher doses of Pred the pain is masked, but all the while the osteoarthritis is deteriorating without you realising it.

However, Pred does sometimes hamper the healing process post operation.

But as PMRPro says - you must discuss with doctor.

[suzy1959]

Like you, I have also had 3 joint replacements and will have the final knee done next week. My pain has now reduced considerably- both my hips are wonderful, the knee less so- so I am surprised you are still in such pain. Where is your pain? Is it in your new joints or elsewhere? Personally, I think the OA is worse for being on Pred.- damaging the cartilage- but the pain is definitely the OA, not the Pred. I am on 11mgs. Pred. currently and haven't been able to reduce at all while I've been having these operations. I have had a flare after each one!

[PMRpro Ambassador in reply to suzy1959]

Was the flare related to the rehab activity as well? I've just had a very painful couple of weeks, definite flare, but I'm pretty sure now that a lot has been due to more walking that has made a few things protest loudly. It was unavoidable at the time - and believe me, I do know how to minimise my PMR discomfort so if I say it was unavoidable, it was!!

[suzy1959 in reply to PMRpro]

I think it was more to do with the trauma to my body and the pain! Thus, I had 2 flares when it was my knee replacement- the pain was much worse than with the hips. I don't really know though.

[albatross in reply to suzy1959]

hank you, you say "damaging the cartilage" and that is what has happened to my knee and two hips and that is why I think it is the steroids. I will not stop them suddenly of course but I will discuss with my doctor about cutting down and eventually coming off them.

My pain is worn sacroiliac joints in my pelvis and now a twisted spine with two vertebrate moved which is causing back pain and sciatica.

[PMRpro Ambassador in reply to albatross]

Like everything else, it isn't certain it is the pred - except perhaps to speed up something that would happen eventually anyway. I was told I had OA in my knee, the doc claimed she could "feel it" but 13 years later after at least 8 years of pred above 10mg/day a more scientific assessment using x-rays found there was no sign of cartilage damage.

[Blearyeyed]

Did the Doctors involved in your surgery explain why the operations were being done and what had caused the damage?

This will be the cause for your surgeries. Steroid use , for some , only has an affect on the speed that the surgery might be required that was caused by other Health , Bone or Muscle/ Tendon conditions.

You wouldn't stop your steroids abruptly , this is dangerous , your steroids at the moment will also help the inflammation and stress on the joint that has been replaced , in other words , it will be helping you control some of the Pain from Surgery rather than making it worse , just as it helps manage the Pain of your PMR.

If you Pain is out of control at the moment , after Surgery or Injury Stress , and it isn't helped by use of Paracetamol or other prescribed Nerve / Pain Medication and Rest and Recovery Techniques rather than reducing Steroids you may actually be advised to increase them . You can't be sure if the cause of the Pain is the Surgeries or a Flare in the PMR.

Uncontrolled Pain after Surgery when you have a Condition like PMR needs professional Medical Attention and Support ASAP.

They need to advise you on your required Steroid dose to cope with Stress , offer additional Pain Relief if required, and examine the surgeries themselves in clinic and via x-rays or scans to make an educated decision on wether any other issues or surgical complications are causing the Pain.

Please make an appointment , or if you have had one but don't feel you got an adequate response , go back to your Specialist , or even get a Second Opinion.

[V1a4]

I try to separate my OA (sixth op upcoming) and PMR in my mind, whilst still making sure my surgeon and others are aware of my pred needs. I did try to reduce to 2.5 mg before surgery but am now on 4/5 alternative days, but I believe it's PMR flare up due to the weight of being on crutches, and not the ankle joint - my latest OA nuisance. I know it's easy to say but try not to stress, it will all work out in the end but don't stop pred. Wishing you well.