Low-dose pred for osteoarthritis after PMS

[Moralis]

I was diagnosed with PMR in November of 2017. Prednisone worked like magic to take away the pain, although I hated dealing with the side effects. This week, after doing a very slow taper, I am now off prednisone completely. However, I have developed arthritic pain in both knees, (not PMR) and my rheumatologist suggested I go back on 3mg of prednisone a day to help with the inflammation. I work out and do physical therapy, which helps. (I cannot take NSAIDs because I am on a blood thinner.) I'm curious to know what the website experts think.

[DorsetLady PMRGCAuk volunteer]

Hi,

Oral steroids are not normally used for osteoarthritis as such although a study last year did suggest they might be useful in hand arthritis -

medpagetoday.com/meetingcov...

Steroid injections are given directly into larger joints, but the success is a bit mixed (I’ve found them useful in the past) and there is a worry that the practice may in time have an adverse affect on the tendons surrounding the joints.

I found that high doses of steroids (GCA) masked the OA pain, but lower doses did nothing for it - and a lot higher than the 3mg your Rheumy is suggesting.

But as you are limited in what pain relief you can take - it’s worth a try!

I’m sure they will be many on here interested in the outcome.

PS just had my third joint replacement - so if a small dose of Pred helped I might even consider it!

[Parami in reply to DorsetLady]

That's interesting. I have arthritis in my thumb joints, and usually suffer during colder weather. Since being on Prednisolone, I have hardly noticed any thumb pain.

[DorsetLady PMRGCAuk volunteer in reply to Parami]

Well that’s one good thing then. I have it in my right thumb joint - like you not constantly - so when it comes on, it’s always a bit of a surprise!

[PMRpro Ambassador in reply to Parami]

My thumb pain is due to the PMR.

[Parami in reply to PMRpro]

I had my thumb pain before PMR, so expect it to return when finally off Prednisolone.

[PMRpro Ambassador in reply to Parami]

Mmmm - but how long before PMR? Most of us can identify things that could well have been the first signs of PMR - it doesn't always hit overnight as they keep suggesting, that overnight effect is the point at which it all coalesces and bang, you have obvious PMR.

[Parami in reply to PMRpro]

That's true. I look back and remember the odd niggles that were easily put down to my age, or doing too much with the grandchildren.

[PMRpro Ambassador]

I'd take it if it works - way ahead of NSAIDs, anticoagulant therapy or not. 3mg isn't even enough to suppress adrenal function.

Longterm low dose pred is actually used to manage some cases of rheumatoid arthritis - it isn't discussed much but there are doctors who realise that, in late onset RA which often doesn't have joint erosion for a very long time if ever, there are fewer risks than with NSAIDs as a first line therapy.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Must admit I’ve thought about it, but as my OA pain “came back” even on doses about 1Omg guess it probably only works on certain people or rather certain joints (as Italian study).

But I would rather Pred than Co-codamol (even v.small dose) if it worked.

[PMRpro Ambassador in reply to DorsetLady]

OA is different from RA though.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Yes I know, which was why I was surprised at suggestion - but the research was on OA patients, so maybe it will work - but you’d probably need more than 3mg.

But, as someone who’s suffered from OA for a good number of years - and needed replacements - you’re willing to try almost anything!