Does paracetamol offer equivalent relief for Paramylgia Rheumatica as steroids?

[aquadeus]

I have reduced my steroids to .5 mg from 15mg 2 years ago because of the side effects. I am hoping that paracetamol will give me relief but my symptoms have returned and are as bad as at the beginning. It is the first 2 hours of the day that are the worst and the paracetamol helps in this respect. Do I just suffer or revert to more steroids again??

[MrsNails]

Hi Aquadeus

We discussing this yesterday, paracetamol will not help with PMR per se but it might help with general aches n pains.

What are the side effects that the Pred is causing you issues?

It may be worth going back to 2mg to see if you improve, Professor Dasgupta keeps many of his patients on low dose Prednisolone to prevent PMR recurring but if your side effects are a problem then that may not be the best way, l will attach the post from yesterday shortly.

Kind Regards

MrsN

healthunlocked.com/pmrgcauk...

[aquadeus in reply to MrsNails]

Thanks for your response! My pain is in my shoulders, hips and knees. I then developed pain in both my wrists so am interested in the comments about how frequently this is happening to other PMR sufferers!

As well as the Pred I am taking omeprazole tablets. I have itching in my ears and under my arm pits and chest and am thinking these are side effects. I was thinking of going off the Pred completely and relying on paracetamol. Previously I took paracetamol and ibuprofen which worked well, but my doc said not to take the Ibuprofen as much. After 11.00 am I seem to function reasonably normally.

[PMRpro Ambassador in reply to aquadeus]

Neither paracetamol or ibuprofen are innocents in the context of long term use and adverse effects. Neither are particularly good for the kidneys, paracetamol can lead to liver damage and ibuprofen have cardiovascular effects.

One lady was persuaded to try paracetamol because her GP was sure that her pain was due to arthritis not PMR. Within a few weeks a routine blood test showed high liver enzymes, high enough to trigger an emergency referral for a liver ultrasound. Luckily nothing was found - stopping the paracetamol sorted the raised blood markers!

[PMRpro Ambassador]

No is the short answer to your question. No pain killers will do more than take the edge off the pain of PMR. It might help pain due to other causes.

Are you sure this is a return of PMR? If paracetamol is helping the morning pain then it could be something else. But don't forget - the inflammation that is causing the pain and other symptoms is also doing damage to your body tissues. Long term low grade inflammation is known to be a risk factor for cardiovascular disease and some cancers. It isn't a simple case of pred bad, no pred good.

[SheffieldJane]

Has anyone discussed your Adrenal Function with you? It might be something to raise with your doctor. Your own system is having to produce the Cortisol now and it can take a while to normalise. Your morning aches may be related. A Synacthen Test would tell you if your own Adrenal Glands are producing enough for your requirements.

[aquadeus in reply to SheffieldJane]

Apologies for delay in responding! Under Doctor's instructions I reduced from 2 mg of pred for a month to 1 for a month to .5 for a month so hopefully body is again creating own supply.

My next appointment is next week and I will ask about a Synacthen test. The pain from my PMD is back to the levels experienced before I started with Pred. Interesting that inflammation also does damage.

Does Pred actually cure pmd or merely disguise the pain till the body recovers naturally? Where is the logic of gradual reduction? Is this to establish a level of pred that confuses my reaction to pain?

If I can bear the pain am I better to do this than take pred?

[SheffieldJane in reply to aquadeus]

It just reduces inflammation like a super, duper painkiller but also prevents the damage the inflammation does. Let’s face it, the disease is made tolerable. A slow taper enables us to arrive at the lowest most effective dose ( without missing it).

[PMRpro Ambassador in reply to aquadeus]

I would always support taking pred - and I would also suggest you did that last 2mg too fast. The doses are so low that taking 2 or 3 months at each step to be sure it is still enough is not a problem and many people find that 1mg, even 1/2mg is enough to keep the inflammation down. When they stop the dripping tap of inflammation builds up to a level where they are back to the beginning with symptoms. Even the UK guru Prof Dasgupta told us a couple of months ago that he keeps patients on 2-3mg long term as he finds that prevents relapses. Why suffer for the sake of a mg of pred?