Pain and fatigue at 8mg

[Mstiles]

I was Diagnosed Jan. 2018, PMR/GCA, and put on 40 mg of pred.

Over the past few months I’ve had increasing pain in the sacral joints and lower back, some temporary neck and shoulder pain and stiffness, stiff neck when turning head to the side, elbow pain when holding a book up to read for long periods. Also had some brief abdominal pain and constipation. The pain is worse at night and in the mornings when waking up. Bending from the waist is especially painful! The pain varies, some days worse than others and gets better as the day goes on. I’ve also lost weight, especially thigh muscles and lost a bra cup size! And am really tired and depressed.

My GP ordered an X-ray, lower back and abdomen, which showed osteoarthritis in the sacral joints and some collected stool. She said use pain patches and Metamucil and Colace. They’ve improved things but I still have some pain. Tylenol helps slightly. I took ibuprofen 8mg, once, and it did help. My GP also said Physical therapy would help the arthritis. I’m currently without a rheumy as mine left the practice last month, But the GP agreed to prescribe pred for now.

I had bloods done 1/14: (major stress, friend’s accident and on life suppprt. She’s still in rehab but will never be the same.)

Sed rate: 12: (0-30)

CRP: 4. (0-9)

Bloods done 5/29:

Sed rate: 25 (0-30)

CRP: 2.9 (0-9)

Questions:

1. Could this pain a flare of PMR/GCA ? I didn’t have this kind of pain in the sacral joints before with a flare.

2. Should I ask my GP to do any other tests to look for something else?

3. I’ve been on 8 mg for a month, can I resume tapering if this is just osteoarthritis. I haven’t tried increasing pred to see if it gets rid of the pain.

Thanks everyone.

[PMRpro Ambassador]

I have sacroiliac problems due to myofascial pain syndrome and it is all an integral part of my PMR symptoms. A flare of PMR always starts there. Ignore it and it steadily gets worse. Like you a flooding dose of ibuprofen (800mg) and a hot water bottle work minor miracles! I also have Pain Clinic appointments - and if mine gets bad that is where I would look for advice.

[Mstiles in reply to PMRpro]

Thank you Pro

Would the GP know about myofascial pain syndrome and how to treat it or would a physical therapist be the one to see.

As per your experience I did try the 800 mg flooding and 200 the next day, which did help, but then the pain came right back. I was afraid to continue the ibuprofen.

If ibuprofen helps the pain then it’s not PMR?

[PMRpro Ambassador in reply to Mstiles]

I doubt many GPs would recognise it - at least not outside central Europe where I live! It is a fairly new concept for mainstream medicine in the English-speaking world. But a physical therapist or therapeutic massage therapist should recognise the spasmed muscles that are such a large part of it.

The 200mg might not have been enough - after the 800mg I find a 400mg dose continues the effect and you need it less often overall. Take it with food or use a PPI and you should be OK - according to my rheumy at least!

Basically yes - it might help briefly or take the edge off but it won't manage PMR pain more than that usually.

[Mstiles in reply to PMRpro]

Do you just take the 400 dose once after the 800? And then use the ibuprofen occasionally when the pain flares?

Thank you.

[PMRpro Ambassador in reply to Mstiles]

You just have to try it - usually with back pain 800mg usually works for a good 12 hours and then the 400mg takes me quite a while. It's just the way ibuprofen works, you need this flooding dose and then you seem to manage with less by taking fewer larger doses. You just have to try.