Meloxicam as an alternative to prednisone.

[Hankb]

A friend of mine has had PMR for approx 6 months and has been taking prednisone during this time. She recently changed her doctor and her new doctor has now told her he is concerned that she has been on pred for so long as it can cause osteoporosis. He has now prescribed for her Austell Meloxicam one per day (not sure of the dosage), and 2.5mg pred per day. She has been on this regime for a week and says she no longer has pain and is able to climb the stairs and sleeps well at night and she says she's feeling so well.

Does anyone on the forum have any knowledge of Meloxicam.

From my research the side effects of Meloxicam are frightening.

[Songbird69]

Hi, I know nothing about this drug but I googled and it says it is recommended that it be used for as short a period as possible and at a low dose, presumably because of side effects? So how does her new doctor believe that her PMR will be gone within this “short period” I wonder, particularity as her PMR is likely to go on for years - unless she is one of the lucky ones.

Worrying I would say. I would rather stick with the Pred!

It will be interesting to see others points of view.

[123-go]

Having had a quick look online at meloxicam, I wouldn't even consider it.PMR lasts 2-5 years in most patients but can last for much longer in others. There is a concern that Pred may cause thinning of the bones but this can be mitigated with adequate vitamin D and calcium by way of supplements, diet and lifestyle changes.

It is clear that your friend's doctor has scant knowledge of PMR and its management-scant being a generous appraisal. She needs to find a doctor who is knowledgable.

Do you know what your friend's PMR symptoms were at diagnosis and her initial dose of Prednisolone?

[PMRpro Ambassador]

My immediate concern is that this is not PMR - if Meloxicam works, that is a cardinal sign and she needs referral to a rheumatologist for diagnosis. Typically it will work in patients who have an inflammatory arthritis with a polymyalgic presentation.

I've taken pred for nearly 12 years with absolutely no sign of osteoporosis - but I certainly wouldn't take Meloxicam for 12 weeks, never mind 12 years. I have no idea what it is that makes doctors so terrified of using steroids but they will hand out opiod painkillers and NSAIDs like sweeties.

medicalnewstoday.com/articl...

There is an increased cardiovascular risk with them and some COX inhibitors have been taken off the market. Meloxicam is associated with a 38% increase in CV risk so its use should be minimised:

pubmed.ncbi.nlm.nih.gov/290...

But she needs more investigation - maybe the doctor will have done her a favour in the long term.

[Hankb in reply to PMRpro]

She is going to make an appointment with a rheumatologist after I told her about the feedback I've had from the group. I've suggested to her that she should join but I think she has a problem accessing the internet as the cost of data is expensive in South Africa.

Many thanks you for the information.

[PMRpro Ambassador in reply to Hankb]

That's a shame - is there no access to public hotspots?

[Hankb in reply to PMRpro]

There are hotspots in Cape Town but she lives quite a way from there so it's not really practical for her to travel in. I pass on whatever I think is relevant to her from what I pick up from the group. I think she has benefited from the advise given so far in particular the fact that she might not have PMR but possibly some form of inflammatory arthritis. She has made an appointment to see a rheumatologist which hopefully will put her on the right track. Thank you for your advise.

[123-go]

Have just seen PMRpro's reply and I have to say that I, too, suspected the diagnosis of PMR which is why I questioned symptoms. Symptoms of PMR are seen in many other conditions and these should be ruled out through investigations before a diagnis of PMR is made. In addition, a dexa scan should be carried out before prescribing medication for osteoporosis.

[Croft9232]

I am actually taking Meloxicam along side my pred , it was prescribed by my Rheumie on the last telephone consultation! I mentioned that my OA was giving me a lot of pain, especially my hip.. He said that some specific trials at James Cooke( my hospital) were very promising in its use 😬will have a rethink now, It does seem to be a problem what meds to take when you have both PMR and OA..Anyone any thoughts on that.

Margaret.

[PMRpro Ambassador in reply to Croft9232]

It is very GOOD I think, hence the surge in interest, But I would be unhappy about longterm use.

Does paracetamol help? None of the painkillers is innocent but keeping the doses low and maybe using two different ones may be another option.

Who is your rheumy at JC? I knew Mike Plant.

[Croft9232 in reply to PMRpro]

Yes it’s Mike Plant... I’m not convinced Meloxicam is doing much for the pain just creeps in as I go lower with pred ... currently 3mg and only 24 months since dx. Hmmmm. I am having a steroid injection in the Piriformis too just waiting for the appt..Have to say all my treatment at JC has been excellent.

[PMRpro Ambassador in reply to Croft9232]

I wouldn't be convinced about Meloxicam in PMR - no other NSAIDs help, why should it! And the international guidelines aren't enthusiastic about NSAIDs.

[Bcol in reply to Croft9232]

Morning, I have been managing my OA for about 30 years, and initially on Naproxen and Co-Codamol, for many years now though the only pain relief I use is Co-Codamol 30/500. I don't find any problem with that and the Pred although I accept that Co-Codamol doesn't suit everyone.

[piglette]

Meloxican is an NSAID, which invariably do not work for PMR. It looks like it may not be PMR if it is working so well.

[Croft9232 in reply to piglette]

My Rheumie prescribed it along side my Pred to help with the OA that I have, specifically in my hip, nearly ready to go on the no doubt very long waiting list for a replacement. Steroid injection in the Piriformis to help hopefully with my Sciatica. So far so good with my PMR.

[piglette in reply to Croft9232]

Hip problems are really painful, I know!! Have you got your name on the waiting list, it is worth it? Your rheumie should know that steroids and NSAIDs are counter-indicative.

[HeronNS]

For followers of this thread: if tempted to use any NSAIDS regularly for the relief of OA, please know that these interfere with cartilage renewal and in the long term are counter-productive. I am writing as one with quite extensive OA who has been suffering quite a bit this past year, and I never use these medications for the OA - merely enjoy the occasional relief when I have to take aspirin for a headache!

I am a long time user of glucosamine, and believe this is at least in part what has helped me manage nearly half my life with an OA diagnosis and not yet a total cripple! I also think that pred has not been helpful, but in that regard I have no choice but to take it.