What is a PMR flare?

[singingloud]

As I go down on my prednisone, can you tell me what a PMR flare is like? Thanks

[Yellowbluebell]

Hi, a pmr flare is a return of your original symptoms at the same level or even worse than before. Do you think you are having one? YBB

[HeronNS in reply to Yellowbluebell]

Actually I never let a "flare" get bad enough to be like pre-treatment condition.

[Yellowbluebell in reply to HeronNS]

Neither have i but some people dont recognise them in time and assume its either pred withdrawal or something other than pmr. I didnt realise the reason for me feeling like death a few weeks ago was because i had been taking 2mg rather than 10mg!! Luckily three days of 15mg stopped it in its tracks but i felt a right idiot for not realising sooner!!YBB

[Hidden in reply to HeronNS]

It's very easy to go into denial or confusion when there are comorbidities that have overlapping symptoms. The most full blown flare for me was around 5 or 6 months in before I rely found the forum. I flowed the Dr's reduction orders and felt worse and woes... But i didn't know then whether that was normal. Found forum, back to doctors.... Inflammatory markers higher than at dx at 8mg. Back to 12, then 13, then rheumy....

[HeronNS in reply to Hidden]

Yes I've recently (oddly, not so much at the beginning) had some trouble distinguishing between PMR and osteoarthritis. The OA is quite a bit worse than I remember, but I think that's because pred has been hiding it for so long. Soldiering on....

[Hidden in reply to HeronNS]

Yes it about humidity too. My hands, thumbs really have been swollen and inflammed in the warmish humidity. I think it helps if you know you had OA previously in a joint.

[HeronNS in reply to Hidden]

Warmish humidity? Not here! But in the olden days (first diagnosed with OA over 30 years ago and I'm sure I had it longer) it seemed I might notice it more in the summer. I suppose the tissues swell in warm weather.

[Hidden in reply to HeronNS]

It was 11c at 10pm last night and very humid. My right thumb is half it's size again. 👍

[HeronNS in reply to Hidden]

We did have temps above freezing and fog a few days ago, but it wasn't what you'd call warm. Below freezing again but rising now. In the past the recent rainstorm would have been snow, and everything would have been cold enough to kill off invasive species (bugs like disease-carrying ticks) not used to the cold. No more!

[Hidden in reply to HeronNS]

That what I want a good freeze for too. To give all my garden weeds and bugs a good clear out so less work for me!

[HeronNS]

There is a difference between pred withdrawal and flaring up of PMR symptoms and the way we usually can distinguish between them is that pred withdrawal happens very soon after tapering a dose, sometimes as soon as the next day, and diminishes as the body gets used to the lower dose. If the disease is no longer properly controlled, however, inflammation begins to build up and discomfort increases over time, until one day you know it's the PMR. As YBB says this can be as bad as or worse than you remember the original condition, but it's best not to let it get to that stage.

[Dea1313]

You will know when you have a flare. The pain is almost as bad as when it 1st started... It's better not to get to that stage by tapering very slow... There is a difference between a fare and preds withdrawal... neither are nice

[SheffieldJane]

Flares are not inevitable, I have never had a fully fledged one. I have had twinges and felt unwell in some of my recent tapers.I have gone very slowly and have cut my 1mgs in half since 10 mgs. I have had diagnosed PMR for 4 years. I got stuck at 7 mgs for a year ( trying and failing to taper) and suddenly I could. I used a dead slow and stop method that is pinned on here. Are you worried that a flare is threatening? Stress can trigger one, tapering and acute illness or simply overdoing things. I am on 4 mgs ( a bit wobbly of late).

[Hidden]

I eventually started to recognise steroid withdrawal symptoms were based around intense shoulder pain for a few days after the taper. Painkillers helped. Withdrawal is still iocated in my right shoulder and arm.

For me a flare, of which I had an almost full blown one last year, was based in thighs, with aching and claudication, night sweats and I have realised a level of irritability that erases my normally happy go lucky demeanour. It took a few weeks of trying to ascertain which of my health issues was the culprit that started decline. Its not about obsessing about every twinge... For me it's patterns. It's about educating yourself about your body and the symptoms of withdrawal and/or adrenals trying to wake up. I

[Meggsy]

I took three attempts to taper from 10mg. Strangely my symptoms weren’t similar to original ones. Pain began in my fingers and continued to hands wrist and elbows when I went back to ten. Since then have tapered by 0.5mg. Presently nine days into 4.5, so past withdrawal time and fingers crossed re flare - 10 weeks on 5 mg.

[PMRpro Ambassador]

A flare is just a return of the original symptoms because either you have reduced the daily dose too far or the activity of the underlying autoimmune disorder has increased.

That is why we suggest waiting a bit after completing a taper before reducing again and counsell against reducing every week - you need to know that the new dose is still enough. If you just keep bashing on you may have no idea where it went wrong. But any, even slight, return of symptoms should signal you need to stop and review for a few weeks. If it gets worse it is likely to be a flare, if it improves then it was more likely to be your body protesting at the change.

[Janstr]

I have GCA and PMR & have had 2 flares & in both cases a blood test showed increased CRP. I now have a baseline blood test before starting a taper. I know that raised CRP isn't necessarily a flare, but could be.