Beginning of a flare or arthritis?

[AussieMel]

Seeking some input...have been very slowly tapering (0.5mg every 4-6 weeks), now on 6mg. Over the past 2 weeks I've had increasing stiffness and pain in my hands and loss of strength, and also in my left knee.

I normally walk every day but I'm experiencing a lot of fatigue.

Could this be arthritis or the start of a flare?

I take magnesium, Curcumin, flaxseed, calcium and use Osteo Panadol for aches (and Epsom salt baths). For diet, I'm eating low carb/low sugar/Mediterranean

Cheers and thanks in advance.

[SnazzyD]

I don’t know about the flare bit but the fatigue may well be because you’re coming into the dose area where your artificial cortisol (Pred) is not quite enough for a day’s doings but still a bit too much for your own adrenal glands to realise they need to produce the natural cortisol to make up the shortfall. I felt I’d hit a brick wall, feeling tired, fluey achey, emotional and weak. It started to improve around 5mg when I think my adrenal glands finally got the memo. Do the pains feel like your old PMR?

[AussieMel in reply to SnazzyD]

Thanks for the reply Snazzy.

Hmmm....no, they don't really feel the same - as far as I can remember.

I've had a pretty good run since my last flare in March 2020 when I think the stress of the bushfires here in Oz and Covid plus my Dad having a heart attack gave me a triple whammy and I went back up to 25mg from 6mg.

I guess I'll ride it out a little longer and monitor for any increase in pain and stiffness. I feel (hope?) like this may be the difficult patch you speak of as my adrenals start to kick in.

It's just hard to know which it is.

[PMRpro Ambassador]

If it were me it would be the signs that the dose is borderline not enough and I'd go back to the previous dose to see if it improved matters. I've come to the conclusion that even a small amount of inflammation lasting longer through the day than usual leaves me far more fatigued - and much more weather-sensitive for some reason.

[BlueLara in reply to PMRpro]

I seem to be very weather-sensitive recently so am relieved to see that it may not be just me. I have osteoarthritis and spinal stenosis as well as PMR (which does seem to be under control on a low dose) so have an assortment of aches and pains!

[Meggsy]

My flares on the way down have always involved my hands and wrists about 2 weeks after decreasing the pred dose. The most recent one was at 3mg. I had pain and extreme weakness in my wrists and usually strong hands. I picked up my 5 month old (plump) grandson and had to hand him over to my husband as I thought I would drop him. Hands and wrists were never part of the original symptoms. I increased by 5mg and all was well again. Presently on 5mg and cautiously on the way back down. On second thoughts I went up to 10 mg for a few days to begin with so actually increased by 8 mg.

[PMRpro Ambassador in reply to Meggsy]

I wonder if the few days at 10mg and return to 4mg would have worked?

[Meggsy in reply to PMRpro]

You are probably right PMRpro, but I fear I am ultra cautious. Will just stay at 5 or a little longer as I am presently four days into a bout of shingles. Fortunately I was able to get a dr’s appointment and prescription within 6 hours of rash appearance.