Is this a flare?

[Mack100]

Hello all

I was diagnosed with PMR last September, commencing dose of prednisolone of 15mg raised after 1 month to 17.5, since then my GP has allowed me to manage my reducing regime. Even at 17.5mg I had pain in my left wrist/hand which was treated successfully by NHS physio. I have a history of severe trauma to my left shoulder/arm.

In May when I was on 10mg ( using DSNS) I started back exercising, mostly free weights and exercise bike. After a month the pains in my left hand returned severely and I stopped the weight training. I am having private physical therapy for this. I am confused as to whether this is a flare due to reducing steroid dose or some re-activation of my old injury due to excessive weight training. I have no other symptoms of PMR elsewhere in my body.

[DorsetLady PMRGCAuk volunteer]

Personally I would go for a recurrence of old injury - which at higher doses of Pred may have been masked by the drug.

PMR pain is usually bilateral - but if you have a pre-existing condition on one joint that can be more affected.

Have you tried ordinary painkillers and is the therapy helping ? If the answer is yes to either, it’s probably not PMR - but it might be sensible to temper the weight training - repetitive exercise is not helpful with PMR - muscles not as resilient and takes longer to recover.

[PMRpro Ambassador]

I assume OA has been ruled out? Otherwise I would be inclined to think you got too enthusiastic too quickly with the weights. Both the PMR (which has a lot of tendonitis involved) and pred will make tendons delicate and intolerant of acute exercise. A lot of people find that PMR heads straight for any delicate structure - you have a war wound of the sort that is likely to attract it. My PMR was probably first active in the form of what I thought was RSI in first my right wrist and then the left joined in - and if I flare now it is the right wrist I notice first.

We often suggest to people to use VERY light weights if they are using weight training - but maybe starting low and building up but not to the previous level might work?

[SnazzyD]

I started off very fit indeed in 2017. I am now having to do what I would have classed as pretty feeble exercises just to be able to get strong enough to go to a gym. So much can happen to muscles, ligaments and tendons that it isn’t the same as getting over a bout of the flu and going back your old regime but just a bit lighter.

[Mack100]

Thanks for the comments. I'm certainly hoping that the wrist and hand pain is due to excessive zeal in my weight training rather than a manifestation of the the PMR but I suspect that both may be involved, they are not mutually exclusive after all.

PMRpro makes an interesting point about PMR heading straight for any delicate structure.

When I was a student over 50 years ago we were taught the concept of "locus minoris resistentiae" which means a body region more vulnerable than others often due to history of trauma.

pubmed.ncbi.nlm.nih.gov/251...

It's not taught in med school now but still held to be relevant.

This would certainly fit in with the way both PMR and the side effects of any treatment can affect us. As part of my history of injury I have paralysis of the the large leg muscle, gastrocnemius, in my right leg which leads to a situation similar to venous insufficiency in that the muscle pump does not work and this can lead to skin problems on the calf.

About a month after starting prednisolone I developed a stasis eczema over that region. I am managing this myself as it was a condition I used to treat professionally but I'm convinced that when I stop the pred it will resolve in time.

It would be interesting if any others in the PMR club have had old injuries or similar manifest themselves as a result of PMR or prednisolone.

Sorry to ramble on.....

[Whippetygirl in reply to Mack100]

I had surgery for Spinal Stenosis and one day when I forgot to take my Prednisilone at 7am, by 4pm my body started to object. The pain over my lumbar spine was unbearable and painkillers did not help, I did not realise what I had done until I came to do my daily medication for the next day so I took them straight away and then took the next day at the usual time. So yes , previous trauma is very vulnerable.