Pred hiding or lowering inflammation?

[cassie1208]

Yesterday I started on 5mg from 3 months at zero. I’m trying to zap out the pain.

My question is:

Does the Pred mask the inflammation?

Or does the Pred actually lower the imflammation?

[MrsNails]

Hi Cassie

The Pred dampens down the inflammation in PMR/GCA or ‘Mops it Up’ as we sometimes say on here but it tends to kick back very quickly if we are not taking enough. What we aim for is the lowest dose possible to keep us comfortable.

I don’t think l’ve ever had that ‘Miraculous Feeling’ of improvement that l did after l first started on Pred but l know what it’s like to be on too low a dose.

PMRPRO will give you the best explanation of how Pred works. She’ll be along shortly.

I hope you feel better soon.

Kind Regards

MrsN

[cassie1208 in reply to MrsNails]

Hi Mrs N

You are all so kind here and I can 100% rely on useful info when I need it. I like mops it up as a way to visualise it. What stage are you at?

Best wishes

Cassie

[MrsNails in reply to cassie1208]

Oh Cassie, l’m one of the Long Timers 😉 currently just been put back up to 13.5mg Prednisolone & 25mg Methotrexate but l never do anything the easy way.....

If you want a bit more info on me click in my photo (Avatar)

Best Wishes

MrsN x

[SnazzyD]

Here’s something to go on while PMRPro has her morning coffee and gets her hat on. Steroids are not pain killers in the usual sense, but they do stop the production of inflammatory substances that go on to cause the pain. Some pain in inflammation is due directly to the effect on the surrounding nerve endings but the other main cause in PMR is the effect of the inflammation narrowing the blood vessels so the blood supply to the muscles. Upset the blood supply to anywhere and it’s painful. These substances that we ‘mop up’ are part of the complicated system of substances that cause the inflammation. You may have seen mentioned Cytokines in posts and these the main ones and Pred is great because it stops most if not all of them.

[cassie1208 in reply to SnazzyD]

You have explained this really well so I understand now thanks

[PMRpro Ambassador]

Pred combats the inflammation, reduces it.

The heavy science bit:

"Corticosteroids are the most effective anti-inflammatory therapy for many chronic inflammatory diseases, such as asthma but are relatively ineffective in other diseases such as chronic obstructive pulmonary disease (COPD). Chronic inflammation is characterised by the increased expression of multiple inflammatory genes that are regulated by proinflammatory transcription factors, such as nuclear factor-kappaB and activator protein-1, that bind to and activate coactivator molecules, which then acetylate core histones to switch on gene transcription. Corticosteroids suppress the multiple inflammatory genes that are activated in chronic inflammatory diseases, such as asthma, mainly by reversing histone acetylation of activated inflammatory genes through binding of liganded glucocorticoid receptors (GR) to coactivators and recruitment of histone deacetylase-2 (HDAC2) to the activated transcription complex."

i.e. they work on the pro-inflammatory genes in SOME forms of inflammatory disease - they don't work on some sorts of inflammation. They interfere with biochemical pathways that are creating the substances that cause the inflammation.

This

my.clevelandclinic.org/heal...

puts it in people-speak

For us they have two effects - stopping the development of the inflammation but also calming the immune system down so it is less reactive.

So it mops up the messy puddle while also slowing the flow of water out of the bucket

[Thelmarina in reply to PMRpro]

Last line memorable and superb 👍😅xx

[artisam in reply to PMRpro]

The wonderful thing about the scientific info you impart is that my rheumy now speaks to me like another medic! Great that he knows not to fob me off, but the downside is I have to Google half the conversation when I put the phone down. 😂😂😂

[cassie1208]

Thanks for your explanation which us useful as I prefer to know a bit about what’s happening. It’s good to know the Pred decreases the inflammation.

I suppose the thing with PMR is to try not to get stressed about it as that could make it worse possibly. I do get thinking too much sometimes and that’s when I get up and change activity or exercise is good for body and mind.

[Purple-Owl]

Thanks DadCue for your very useful explanation of the process. Maybe I'm nit picking, but every little helps in striving to understand what is going on with pmr! I have a small problem with your very last phrase. You say pred "hides" or "masks" the pain a person experiences 'because the amount of inflammation is decreased'. Surely the inflammation could only be said to be masked if it was still there, but causing less pain?