Flare up

[yorkieme]

I hope that someone might be able to advise me so here goes.

I started a flare up two weeks ago,the rheumy had me reducing from 10 to 7.5 which was clearly too ambitious as many of you pointed out.I have since been on 20mg,(1 week,) and she now has me reducing to 17.5mg,am I reducing too soon ? Again.

Although the muscle pain has gone my shoulder joints and hands remain quite painful to the point of not being able to drive/write etc,is this still part of the PMR flare or possibly something else ? Medication doesn't improve it,paracetamol/codeine and clearly the pred' isn't clearing it.I do have steroid induced Osteoporosis but not sure of any relevance.

I would be very grateful for any advice or suggestions as to what it could be.

Thanking everyone in anticipation.

[SheffieldJane]

I would give the flare another couple of weeks before you try reducing again, especially as it’s winter. I would then do a slow taper of 1 mg drops. My OA is troubling me in this damp cold weather too and I know from past experience that Pred can mask the pain. Being unable to drive and write points to really disabling pain and stiffness. This tends to cloud the picture ie is it PMR or OA? I wonder if you would be a candidate for Methotrexate or similar to ease your arthritic symptoms and to enable you to begin a slow taper? It might be worth a discussion with your doctor on this point.

[yorkieme in reply to SheffieldJane]

Looks like you go top of class for the MTX comment,😇 it was only last week that my rheumy put me back on MTX after a three month break to clear out any possible confusion of side effects from the many other tablets/meds that I take. I did my second injection this morning so maybe I need to wait as the senior nurse said it would take a while to kick in.Just to give you a laugh my G.P. still insists that he is treating me for temporal arteritis ...... seriously,and he refuses to remove it from my medical record even though the Rheumatologist assures me he is wrong,so ! nice as he is I can't see a discussion helping very much.

Thank you for your comment,stay safe.

[MrsNails in reply to yorkieme]

Yorkie, it can take the full 12weeks until you feel the full benefit of MTX so don’t despair.

Good Luck 🍀

[Charlie1boy]

Hi, I totally agree with SheffieldJane about staying at 20mg for at least another couple of weeks - maybe longer to ensure the inflammation has been mopped up. Thereafter, only 10% drops, and see how it goes.

Good luck

Paddy

[yorkieme in reply to Charlie1boy]

Thank you for your response,I really do appreciate the time that you and others give in helping those like me.I think I will take your advice and stick with the 20mg for another week.

[PMRpro Ambassador]

It should still be enough if you had been OK at 10mg and the flare is because of the 25% reduction in dose. Why do they have to be in such a hurry?

I find my hands are the first place to show a flare and they are slow to improve - especially in the sort of weather about at present! But a lot of my shoulder problems come from the myofascial pain syndrome part of PMR and that takes a fair bit of oral pred to sort it out - more targeted treatment is faster.

Osteoporosis per se is not painful - any resulting fractures are though.

However - is it really the PMR or is it something else? Not sure how they use pred in flares of (for example) RA - but then the patient is usually already on a DMARD and adjusting that too.

[yorkieme in reply to PMRpro]

Thank you once again,as ever much food for thought and in particular your focussed response to the hands/shoulder issues.Yet again you manage to verbally prod in exactly the right spot ! Why ? Simply because I am still suffering middle range pain waiting for the broken vertebrae to fully heal,even though I've managed to dump the morphine I'm still taking a mix of codeine/paracetamol.

The interesting point being that I seem all too keen to not take medication if I feel o.k. where as the G.P. insists that I should keep taking the tablets to keep the dose effect constant.

During the last week/ten days I haven't been sticking with the four hour dosage so your comment; Osteoporosis per se is not painful - any resulting fractures are though. seems pertinent.

[PMRpro Ambassador in reply to yorkieme]

And pain relieef only works well when used properly and regularly - once pain breaks through it is hard to get sorted again. Same as with pred ...