Recurring Hip Bursitis

[PhoebeMum]

Hi. PMRand GCA for 5 .5 years and just reducing from 1.25mgs to 1 mg over last 4 weeks. Coincidentally, coincides with another bout of hip bursditis! Had tried increased dose of Naproxen 250mgs taken for arthritis, to 500mgs, no help. Doctor- tried Amytriptalene 5mgs at night, initial help then came back. Now been trying Pregabalin twice a day, increasing dose to 75mgs morning and 50mgsat night. No real change. The grinding ache radiates down the back of thigh to the knee , from the painful spot over the hip bursa.Any thoughts please would be much appreciated from you helpful people.

[PMRpro Ambassador]

Quite why anyone would offer amitryptiline for bursitis does rather defeat me! It may work for nerve pain - but bursitis isn't nerve pain!The buttock and thigh pain could well be due to piriformis syndrome - which can cause sciatica but dealing with the piriformis problem needs to be done before the sciatica will be relieved with drugs.

All these things can be part of PMR - so the reduction in dose may well have taken you below the dose that is enough to keep it under control.

[PhoebeMum in reply to PMRpro]

Thank you PMRpro. I do the Piriformis stretch as I have had bouts of Sciatica in the past , so had hoped it would help . Wretched illness...but many thanks for your help.

[piglette]

Do you think the problem may be PMR? You could always try 5mg for a week or so and see if things change, if not you can always drop back to the original 1mg and try something else.

[PhoebeMum in reply to piglette]

Thank you, piglette , and will try it. I've just had a reply from my physio who can see me on Friday, so , if the extra 5mgs hasn't helped, I'll check in with him. Only one flare before, at 18 months into this illness, so had taken it very very slowly in .5 mgs drop . From 1.5 had started the .25 mg drop 4 weeks ago and was nearly there! Speaking to Rheumy next week, 6 months check, so I can discuss with her. Thank you again, the Forum is so helpful.

[PMRpro Ambassador in reply to PhoebeMum]

It doesn't matter how slowly you reduce - nothing will get you below the minimum dose required to neutralise the level of inflammation at the time.

[PhoebeMum in reply to PMRpro]

Thanks. Even though I had been coordinating a local support group, and had tried to keep the research etc, up to date, it's different when it's yourself!😁 Will certainly get back to the forum in a few days after being on 6mgs. We have lovely sunshine again on the South coast of England, so something good to enjoy.!

[piglette in reply to PhoebeMum]

Best of luck.

[PhoebeMum in reply to piglette]

Thanks.☺

[HeronNS]

The likelhood is it's PMR telling you it's not done with you yet. The painkillers are pretty heavy duty and aren't helping you. Try an extra 5 mg of pred for a few days instead and see if it helps - you will know very quickly. Good luck!

And, my usual suggestion in cases like this, see if you can get some physiotherapy from a therapist who knows something about PMR.

[PhoebeMum in reply to HeronNS]

Much appreciate your prompt and helpful reply,HeronNS. I've been trying to get hold of my physio, who knows my history, for a chat. I do do the stretching exercises recommended for Bursitis , when I remember! All such a bore. ..thanks again.

[HeronNS in reply to PhoebeMum]

It is true, physio exercises have to be the most boring on the planet. This is why I always have radio or tv companionship when I do them!

[PMRpro Ambassador in reply to HeronNS]

That was the joy of my Pilates class in the UK - a nicely choreographed 45 minutes of effectively physio exercises that was really enjoyable. Just as it got repetitive - out came the next installment.

[PhoebeMum in reply to PMRpro]

Hi. PMRpro. Managed a Rheumy triage nurse chat yesterday. ..pursuing the Bursitis diagnosis as the temporary upping of prednisolone hasn't helped at all. And, although I'm not fooled by blood markers, a test was done anyway.! Results normal. She was so helpful ....suggested a short course of increased Naproxen with Paracetamol, ice packs and the Piriformis and similar exercises . Of course, I'm pursuing a cortisone jab from GP, if I can get one in the foreseeable. Hoping that things improve with these measures but I so appreciated your help, thank you.

[PMRpro Ambassador in reply to PhoebeMum]

Careful with Naproxen - still an NSAID

[Nightingales]

I wondered if you have had a hip X-ray. I have osteoarthritis and degenerative spine disease . The hip condition you described is now called trochanteric pain syndrome and involves the bursa, sacroiliitis and often Sacro iliac joint inflammation. I have successful injections in the pain clinic or hip drs office under X-ray or ultrasound. I find the ones done at GP don’t work well.

[PhoebeMum in reply to Nightingales]

Hi Nightingales. Thanks very much for information. Had had cortisone injections by GP in the past. As you say, needs ultrasound for precise guidance so hit and miss ! Had x rays few years ago and just a bit of arthritis in the spine. Sciatica had been a problem.over the years but Pilates had mostly kept it in check. Anyway, have upped the dose to 6mgs from 1.25 mgs today and will try as others have suggested, a few days of that to see if it helps. Help appreciated.

[PMRpro Ambassador in reply to PhoebeMum]

My rheumy does a brilliant job without u/s which is actually usually used for steroid injections INTO joints - and as the trochanteric bursa is a soft tissue all he does is press all over the area until I shriek loudest to identify the most inflamed point.

[PhoebeMum in reply to PMRpro]

Yes, in the past that scenario happened to me, but I was told on the last occasion, when it hadn't helped, I'd be referred to the hospital where u/s was available . But I will call the drs for an appointment for one if the increased dose doesn't help. Many thanks again for all the information.