Long Flare? Or something else.

[Predderman2020]

I have been doing well after a year with PMR. I was on Pred, initially 20 mgs and tapering smoothly down to 14 mgs v slowly with much caution. I had a severe emotional shock on 5th April on a family issue and about 4 days later I had all the usual pain, discomfort & fatigue back. Thinking this is a flare, I went back up to 20 mgs for a 7 days, with absolutely no response. I am still feeling very unwell, but I have reduced to 15 mgs nonetheless, believing that just pushing more Pred at it may not be the cleverest idea. I can sensibly rule out Covid, because I am in Malta and we are under severe lockdown and I am isolated. I have contacted my Rheumatologist here, to ask for a blood test to see if there are raised inflammatory markers or other useful info and I expect to have the blood taken later today or tomorrow. I suppose it could be a standard passing virus that Pred has extended by attenuating my immune system. But needless to say I am worried. Quality of life very affected. I realise that this is difficult for you to tender an opinion, but any ideas would be most welcome. Thanks. T

[SheffieldJane]

Poor you! I am really sorry that you have received this blow. We are especially vulnerable to stress, even the smallest argument can make us feel quite ill. A big emotional shock is bound to floor you. It is difficult at times like these to seek and achieve the emotional support that can be provided by close friends or special family members. You do need that kind of nurturing, understanding and relief though. Please take great care of yourself. Sometimes talking to someone who is not emotionally involved such as an on-line counsellor can assist in getting things into proportion. What you do not have the resilience to do, is solve this by yourself. Seek help. Sending you love and best wishes.

[Predderman2020]

thanks, Jane - I appreciate it. T

[PMRpro Ambassador]

" I can sensibly rule out Covid, because I am in Malta and we are under severe lockdown and I am isolated"

Surely you have had SOME contacts? Someone else told us about having had Covid despite being in lockdown. If you are really unlucky it is far too easy to catch.

It could be a flare - it is well known they can be harder to manage than the original onset and maybe 20mg just wasn't quite enough this time. Hope your rheumy can sort you out.

So sorry you've had a nasty shock - it COULD of course also be the emotional shock is not being mitigated by the amount of pred you are on but I'd have thought 20mg would have at least helped.

[Predderman2020 in reply to PMRpro]

thanks - shopping gets washed, I/we just go out for walks and this end of Malta is very deserted (in Gozo). Always possible, I guess. Children were v good and didn't want to go further than garden and were remote schooled - gone now. I will do the bloods and carry on for a bit and rethink! Thank you. T

[PMRpro Ambassador in reply to Predderman2020]

The chances of fomite transmission (the shopping) is remote it has been decided - but being too close to someone in the shop doesn't necessarily mean the 1-2m thing, if they cough or sneeze and the prevailing wind is in the wrong direction all bets are off.

[Predderman2020 in reply to PMRpro]

Thanks - it may well be - oh dear. T

[tangocharlie]

Back in Nov I had a bit of a flare up, increased to 15 then to 20 then 25 no effect, then tried 40 mg Pred and it sorted everything out. Am now very slowly tapering down but around 20 seems to be a sticking point. I guess what I'm saying is you might need to go up higher rather than just increase a bit? Who knows. My rheumie says to take what I need, that I know best what to do, so I'm kind of on my own and going by intuition and experience.

[Predderman2020 in reply to tangocharlie]

Dear TC - just to match my case with you, could you let me know your PMR characteristics - how long, how is it on Pred when dose is right etc, etc.. If it's not too much trouble. T

[Predderman2020 in reply to tangocharlie]

thank you - how long did it take to bring symptoms back under control at that higher dose? Thanks T

[Predderman2020]

wow - OK - that might be worth a try - maybe we both dropped too low at 15 mgs and it took a while and a much higher dose to get us back off the first square on the board once again. Thanks. T