Can GCA flare be triggered by a fall?

[Phoenix51]

Good morning. I have been on Pred since my GCA diagnosis in January. I have been tapering down and last Saturday I reduced from 12.5mg to 10mg. Unfortunately on the same day I had a fall in the garden, landing on my shoulder and side of head. The next day I had pain across top of my chest, think I must have pulled a muscle, but the pain at the side of my head had reduced but instead I noticed I had some pain in the back of my head and neck. This is still there nearly a week later. I initially took ibuprofen but then upped this to naproxen. I had put the pain/discomfort down to effects of the fall but I am now wondering if it’s a GCA flare due to reduction of Pred? I notice that the pain/stiffness gets worse mid to late afternoon and as I take my Pred around 6/7 pm maybe this is because the effects of the Pred are wearing off by this time? When I had my initial bout of pain that led to the diagnosis, it was in the occipital region, which is where it is now, although it is no where near as severe as it was when I was diagnosed in January. I guess I could go back up to 12.5mg but was hoping to continue with the taper as that was going well. I have recently been diagnosed with increased ocular pressure and glaucoma which the eye dr thinks may well have been caused by the high dose Pred ( I was on 40 then 60 ) I am hoping that the reduction in Pred plus the eye drops will reduce pressure and halt any more vision loss. As an aside I have had a return of my burning shoulders and have also been feeling quite low and lethargic, this is a recent development as prior to my reduction from 15mg I was feeling pretty good. I am presuming this change is due to reduction of Pred? Sorry for the long post. Any thoughts from anyone? Thank you

[SnazzyD]

Hello, that’s rotten. Falls are so frustrating; a silly fleeting moment that scuppers so many things. Don’t underestimate a fall for what it can do, though I don’t mean flare. It used to make me sigh when I was nursing when patients come in describing a fall full of fear and indignance that they felt so bad from top to bottom when a couple of pain killers didn’t fix it. You do so many things when you fall in places that didn’t get the hit. I suspect you got a hefty whiplash which will affect the muscles and their attachments in the shoulders, neck and base of skull. If you hit your head that could have caused a bit of mild concussion even if you didn’t lose consciousness. Did you knock yourself out? Usually whichever bit takes the fall be it hand, knee, hip shoulder, the force travels up to the next bits so someone who braces with their elbow will sure as anything get shoulder pain. The rib cage nearly always gets upset too. Also, people are surprised at how much a fall hits them constitutionally but it really can, especially if you hit your head.

I’m not saying it isn’t a flare, just that with a decent fall, after the first 48 hours of acute inflammation expect two weeks of all sorts of exotic ouchies that may or may not need physio or osteopath etc if there is a sign of chronic upset. The Pred is a good anti-inflammatory as we all know, so when it is wearing off, you’ll feel it. I would probably go back up to 12.5mg just to take withdrawal pains out of the equation for a week or two. For comparison couldn’t have reduced by 2.5mg without kickback withdrawal pain, so I dropped by 0.5mg every 2-3 weeks for the first few mg below 10mg.

[PMRpro Ambassador]

There is a paper that suggests that a fall can be enough to trigger a flare of PMR:

ncbi.nlm.nih.gov/pmc/articl...

A fall certainly did it for me some years ago!

Since PMR and GCA are closely related, considered by many to just be the same disease at different points on a spectrum, if a fall can trigger a PMR flare, it is likely to do the same in GCA. Especially with all the other stress factors around at present.

[DorsetLady PMRGCAuk volunteer]

Hi

Maybe your fall could be why you have flared, but I would be inclined to think it’s due to the fact that you’ve actually gone below the level you need anyway - and the fall was the final straw.

Your reduction has been quick - so maybe time to ease off a bit. It’s not a race, you need as much as you need. You are aiming to find the LOWEST dose that gives you relief not relentlessly reducing to zero - and with GCA it’s very important to keep symptoms under control especially in the first 6 months.

You could try 15mg for say 5 days, provided symptoms gone then to 12.5mg ( not 10mg as that was too low). Then I would reduce my only 1mg a time.

Your pressures should reduce quite soon, I think mine returned to normal around 9mg - but we’re all different- so don’t take that future as a certainty.

[SheffieldJane]

Yes a fall could well have triggered a flare and a return of original symptoms. You could try increasing by 5 mgs for a week to see if you can stop the inflammatory effect. Then go back to 12.5mgs, and stop tapering for a couple of weeks. Are you sure that you do not have an injury that needs medical attention? I should definitely tell your “ good” GP what has happened to you. What a blow!

You do know that we are advised to avoid non steroid anti- inflammatory drugs whilst on Pred don’t you? It is an additional stress on the digestive system. I expect occasionally might be ok, but internal bleeding is a real hazard. Has your doctor suggested that you may also have PMR? Those burning shoulders sound familiar. The fall has been a shock to the system but are you sure that you are not tapering too fast? I also have suspected Glaucoma and Cataracts but have just been put up to 30 mgs. It is a worry isn’t it? GCA is the bigger one though. Wishing you a speedy recovery and hope you are back on track soon!

[Hidden]

Hi, they certainly gave me a good blip and I have PMR. I don't fall as often as I used to but a few weeks before lockdown I did a stupid thing, fell and, in accordance with the finding of the paper linked by pmrpro I increased for a week and took OTC painkillers for the bruises and bumps. I take strong opiates everyday and did have to top up with paracetamol rather than a nsaid after the initial few days, so pain was significant. I had pain and stiffness in my hip, neck and arms. Like a whiplash injury and slathered arnica on the bruised tender bits. I hope you feel better soon.🌻

[Phoenix51]

Thank you all so much for taking the time and trouble to reply, i feel lucky to be able to benefit from such experience and knowledge as I’m very new to the journey. Based on your replies I think I will go back up to 12.5mg and see if things improve, I just didn’t want to go back up too soon and then be yo yoing. I didn’t knock myself out when I fell it was just a shock and on my son’s 18th birthday as well 🙄plus no alcohol involved 😂. I think whiplash is a good way to describe the pain across my upper chest. Thanks for the reminder about nsaid meds I had forgotten 😳 will stick to paracetamol. Thank you all again 🌈

[Phoenix51]

Ps. Thank you for the link PMRpro I am going to have a read of it later when I have quiet time to sit and digest.

Sheffieldjane I am beginning to wonder about PMR although the GP hasn’t mentioned that .. I used to have burning shoulders when walking for more than about 10 minutes or so thought it might be posture related, have also had lots of problems with hips, one side in particular and have had steroid injections into it and lots of physio. Both shoulder and hip have been better over last few months but I’m wondering now if that’s because I’ve been on Pred and now I’m on lower dose those issues are coming back. Can you diagnose via a blood test ? I’m presuming it’s not that simple after reading many of the posts on this forum !!