Undiagnosed: Would dexamethasone shots help if it were PMR?

[Boo0102]

Y’all already helped with one question, so I’ll try another. Due to at first misdiagnosed hip bursitis, I received steroid shot in hip bursa last year. Got some relief, but everything came back. Further testing and they think OA and hip degeneration. So I took conservative approach and get intraarticular hip injections. Relief lasts about 6 weeks. Without going into all my other symptoms, would PMR respond in the short term to large Dex shot? I’m trying to gather info for when I can next see a rheumy.

[PMRpro Ambassador]

I think the steroid shot you got was more likely to have been depotmedrone - that is what is usually used for intraarticular injections and most doctors recommend restricting them to not more than 3 per year because of the potential damage to the joints and ligaments.

I have never seen any work using dexamethasone injections in PMR - the depotmedrone releases slowly over time but requires renewal about once a month. tangocharlie has written about them, she gets them, and there are older posts from Admiral06.

[KellyInTexas in reply to PMRpro]

Yes, I think you must be right.

[KellyInTexas]

Ohhh! A “ y’all” in her vocabulary!

Where are you from? Texas by chance? Or are you a true southern bell?

I only ask about the dexamethazone because it’s being highly touted by a dr in Midland / Odessa for treatment of Covid 19. He said it’s been done is other countries- I think he said Taiwan. ( with good success.)

He’s prescribing it not in an asthma inhaler, but instead in a solution for a home nebulizer. ( less waste, and 90% more medication gets directly into lungs...)

He advocates fast and early treatment- never sending patients home “ to wait and see if symptoms worsen- then seek emergency care.” He said in his mind this is how our county and others who have used this same flawed model have had such poor patient outcomes. Not using early preventive measures goes against most models of known models of top care - he said you would never do that with cancer or heart disease - you must do early interventional medicine no matter what the problem.

In other words- he wants to get ahead of symptoms before they get ahead of the patient.

He was prescribing Zinc along side it to help mitigate viral replication, as well as checking vitamin D levels, vitamin c, and so on.

This was during the Texas surge in late June early July. Not sure what the thinking is now on this medication.

I’m reading your post because I’m dealing with hip ( trochanter) bursitis also... I’m 51. ( can go with lupus.) My rheumatologist is having me do stretching exercises also.

[PMRpro Ambassador in reply to KellyInTexas]

Dexamethasone? Or adding zinc?

The Recovery trial in the UK backs use of dexamethasone.

nejm.org/doi/full/10.1056/N...

[KellyInTexas in reply to PMRpro]

I heard him speak in early June- but he started doing this way before it was approved or written up in any journal for its use in Covid.

He’s become the “ Hero of West a Texas.” He just went a bit rogue early on . But he did model after other successes...

and zinc we are using in Texas quite a bit in our hospitals as part of a vitamin cocktail- along with remdsivir, steroids, LMWH , antibiotics if indicated, ... and Im sure I’m missing a few things here.,.

[PMRpro Ambassador in reply to KellyInTexas]

They were using steroids here very early too according to the anaesthetist I see in the pain clinc and we have always been about a month ahead of anywhere else so it will have been early. There have also been international "seminar" set-ups from early on where experiences were exchanges about things that were being discovered on the hoof so to speak - like delaying ventilation if possible and that early oxygen is important. The UK still seems to be a bit behind on medical care even for relatively mild cases. Shame someone we will not name hadn't chosen dexamethasone to champion instead of something that didn't work ...

[Boo0102 in reply to KellyInTexas]

Howdy folks! Yep, native Texan here for all my 56 years! Much to the chagrin of my very English husband. So we have a lot of mixed vernacular in my house. "We were fixin to leave, but Daddy is still in the bog." And so it goes....

Have you had any shots into the bursa yet? It helped me a bit, but then they did some imaging and then decided it wasn't bursitis, but tendinopathy. Frankly, I don't think they have any clue where all my muscle pain comes from, just the hip OA.

Interesting info on the early Covid treatment using Dex. I hadn't heard that. For my question, it just related to the probable efficacy of a Dex shot into the hip for PMR, even when the shot was not given as treatment for PMR. Not sure if there's a big enough difference in Dex vs Pred, but since they are both corticosteroids (right?), then maybe the effect was the same as long as the med was present enough in the body. Not sure if I'm making sense.

I did read TangoCharlie's posts about her shots, but she's talking about shots directly into the muscle to treat PMR about every 4 weeks, so my question relates to something different (heavier dosage intraarticular to the hip).

[KellyInTexas in reply to Boo0102]

😂 I get it!

My husband is Swiss, and I studied / taught French, German, Spanish.

I had to learn how to teach in British English in Finland of all places.., so if I were to teach any foreign child ( say from Asia or Africa) French or German for example, English would be the common language used.

I’m in the Hill county in Texas near Kerrville.

I’ve not had a shot- I’m on warfarin For Antiphospholipid syndrome so I would likely bleed into the space I think.

[PMRpro Ambassador in reply to Boo0102]

I think the stuff is the same and the dose is actually also similar. The i.m. stuff for PMR uses the 120mg depomedrone injection - intraarticular are often the 40mg or maybe 80mg doses. I have never come across dexamethasone injections being used - possibly because public funded healthcare is able to do a lot of bulk purchasing to keep costs down which doesn't happen in privately funded healthcare. With bulk purchasing there tend to be guidelines and restriction about what is available for use which are often at a national level.

[Hidden]

Hi, thanks for sharing. My knowledge of pharmaceutical matters is anecdotal and therefore I would not give it any credence other than a comment from an unqualified person with no formal knowledge or qualification.

Two issues, firstly the administration of dexamethesone you have received for bursitis, which whilst injected is specific to a determined site, therefore it forms part of a preparation which is targeted and therefore topical in nature. We take prednisilone which has an effect on our whole system, therefore it is systemic. So two completely different delivery of treatments. dexamthesone itself as a systemic preparation, I believe in terms of how “strong” this drug is, I seem to recall that it is significantly more powerful than prednisilone! (?6 times - Dexamethasone is a long-acting glucocorticoid with a half-life of 36 to 72 hours, and is 6 times more potent than prednisone. Prednisone is shorter acting, with a half-life of 18 to 36 hours) On that point I stand to be corrected by those with a specific interest in drugs, however the analogy I would suggest is that using dexamethesone over prednisilone would be akin to using bleach to wash your hands: as effective as soap and water, but not necessary - prednisilone for most of us is appropriate.

Discuss with your rheumatologist, he has formal knowledge obviously, however, were you to be prescribed this drug, it is likely to be at a very low dose due to its “strength”. I am sure someone here has been prescribed it for an acute episode of something, which has not responded to prednisilone, which I was for an acute iritis 40+ years ago.

Please take my comments with a pinch of salt! I have anecdotal knowledge and on that basis and in summary, even if dexamethesone is an appropriate treatment it really is “using a sledgehammer to crack a nut”. Even more so administered as a large shot!.

en.m.wikipedia.org/wiki/Dex...

[Boo0102]

Apologize for taking awhile to reply. I think I didn’t phrase my initial question specifically enough. I’m not asking whether Dexameth is/could be used to Treat PMR, rather if it was used to treat something else (hip OA), would you expect to see a reduction of PMR-like symptoms? Again, I do not as of yet have a PMR dx, but was wondering how PMR would react to a Dexamethasone shot in the hip? Would it have a systemic enough of an impact to address possible PMR symptom? This question is to understand my reaction to shots that I received earlier this year, it for future treatment of any kind.

Understanding that heavy steroid injection would just about cover-up a lot of different muscular symptoms - for a while.

For my experience this year, maybe it’s just a case of whatever it is I have responding to the Dexamethasone, but only for about 4-6 weeks.

Sorry for the confusion. I’m such a noob.

Love from Texas!

[PMRpro Ambassador in reply to Boo0102]

Oh yes - it isn't uncommon for patients to have a steroid injection for some problem and to realise that those other pesky all-over sore and stiff muscles have also improved temporarily. A misdiagnosed frozen shoulder for example could be the start of PMR - as could a hip problem. It is generally bilateral but even the medical literature admits it can start on one side well before other areas are affected.