Trying to get out of a flare

[Sadie1024]

I was down to 5mg, got a flare went up to 10mg with no resolve then went to 15mg and pain stopped. Tried to reduce down to 12.5mg for 30 days but pain just kept getting worse every day after about 10 days on 12.5. Going back to 15 today.

I have inflammatory arthritis in my right knee that is causing fluid buildup in my knee and lower leg below the knee down to my ankle. I think this is causing my PMR to go crazy.

Have any of you ever heard of inflammatory arthritis of the knee causing fluid buildup below the knee all the way to my ankle?

My Rhuemy wants me to start Methotrexate, I do not want to take this medication. It has terrible side effects. What do all of you think about Methotrexate?

I have been on Prednisone since September 2017. Started at 20mg, got down to 5mg and had this flare. I have osteoporosis and I think I may be trying to lower the prednisone to fast so it won't keep causing my osteoporosis to get worse. I can't do enough excercise to keep my bones healthy because my knees are so bad I can't walk without getting fluid on my right knee and a little on my left knee. Do you think the knees are causing my flare?

I will stop rattling on and on now and maybe one of you can give me some advice on what I should do.

[PMRpro Ambassador]

If you have inflammatory arthritis as well as PMR then I do think that methotrexate may well be worth a try. Has inflammatory arthritis been confirmed as the problem in the knee? It is unusual for only one joint to be affected and it is perfectly possible it is something else if it is just one joint, for example gout or psuedo gout. They can be ruled in or out by taking a sample of the fluid and looking at it under a microscope.

Although I found methotrexate caused unbearable fatigue so I couldn't function, many people take it without any problems or ones that can be relieved by extra folic acid supplements or injections rather than tablets. You don't know until you try. There are also other DMARDs that might help.

There are two reasons for flares: one is that you overshoot the dose you required. The other is that the actual disease process increases in activity - a sort of relapsing-remitting form of disease of the same sort of form that is seen in multiple sclerosis. I was quite surprised to discover during a research group meeting recently that doctors aren't as aware of this as we patients are. I know a lot who have been stable at a given dose who then have a flare - most of my flares have been like that. And this type of flare doesn't respond to a short term increase and return to the previous dose - it really tends to be like going back to the beginning and is harder to get under control.

[Sadie1024 in reply to PMRpro]

Rhuemy done a fluid test and no gout. I think you are correct about the flare. I think it is a relapse. I know it is a lot harder to control than the initial PMR.I think I am going to get a second opinion on my knee. The first problem I had on my leg was a hematoma right below the knee. No doctor I have went to have yet to tell me why I had the hematoma. I did nothing to cause it. From that point on is when my knee started getting fluid on it, now the fluid is going down to my ankle and my leg is swollen from my knee to my ankle.

[PMRpro Ambassador in reply to Sadie1024]

I've mentioned a couple of times in the last few days that I had a single session of manual lymph drainage that had an amazing effect on swollen legs/ankles which has lasted.

[regan2]

Hi I have been on Methotrexate for over 2 years now and have not encounted and real side effects. It is essential to have your liver function tested regulary as Meth has an effect on your liver. Reducing your Pred very gradually I found was the key to reducing flares, only 1/2 tablet a week. It takes a while but for me it works. I am now on 2mg Pred & 10mg Meth after getting PMR in Sept 2015. Good Luck