Is it possible to have inflammatory markers controlled and still be experiencing some stiffness and pain?

[Ozark]

My CRP and SED rate are within the normal range on 8 mg of pred, but when I get up in the morning my upper leg muscles, and to some extent, my whole body is stiff. The leg muscles are slightly painful. This all seems to abate slowly as the day goes on, and after about 12 hours seems to be much improved, but then the cycle repeats the next day. There is a complicating factor to this and that is that I am also on a statin which can produce muscle pain. So I'm not sure what the source of this stiffness and pain might be. As an experiment, I've raised my pred level to 10 mg as of today and I'll continue for 5 days to see if that has any positive effect. But my question still remains, is it possible to have controlled inflammatory markers and still be experiencing some degree of pain and stiffness? Your answer will help guide my current and future approach to this issue. Thank you.

[Bcol]

Morning Ozark, Statins can certainly give you muscle pain and problems. I'm on Rosuvastatin (5mg)and have been for many years with no problems at all, but the first three I was prescribed gave me muscle pain worse than my OA. If you think the Statin is involved may be worth chatting to doc to try some alternatives. Your test results can easily come back at normal rates as they are showing that the Pred is doing its job and controlling the inflammation at that time. Is the stiffness and pain something new or been building up for a whole? Have you done anything different that might have brought it on? Another thought, some of us take our Pred (uncoated) at around 02:00 so that its in the system ready to ponce on the nasties (IL6's) when they come out to play around 04:00-04:30. I get no real morning problems and generally get through the day happily. Also maybe 8mg is not quite enough to control the present inflammation.(just re-read your post, so guess that last thought is being tested.)

[Ozark in reply to Bcol]

As of yesterday I increased from 8 mg of pred to 10 mg and that at least for the time being seems to have resolved my issues with stiffness and pain. Thank you for taking the time to reply.

[DorsetLady PMRGCAuk volunteer]

Short answer - yes….

As very often mentioned, anything up to 20% of patients don’t have raised markers at all. Even if you did at outset pre diagnosis, it’s surprising sometimes how long it can take for the inflammation show up, they lag well behind symptoms.

Have you reduced recently, or done anything more active/stressful that could account for the return of symptoms?

See if the increase solves the issue……then you’ll know if it’s a flare provided it’s enough. If not, then you may need to consider other options, as you say.

[Ozark in reply to DorsetLady]

An answer to your question in the above comment, I did very slowly reduce from about 10 mg down to 5 or 6 mg prior to my booster vaccination. I wanted to get as low as I can tolerate. This was back in the middle of August. Then I went back to 8 mg at which time I had lab work done and my inflammatory markers were within the normal range. But subsequent to that, and very slowly, over a period of several months stiffness and some degree of pain crept back in. As of yesterday, I increased to 10 mg a day, and of course, just like a miracle I am much improved today. So I guess I will continue at 10 mg for the foreseeable future even though I hate having to elevate rather than reduce my prednisone intake. Still, all in all, better to have a life without discomfort than not. Thank you so much for taking the time to respond to my post.

[DorsetLady PMRGCAuk volunteer in reply to Ozark]

Well hopefully you won’t be at 10mg indefinitely….but certainly stay there until after Christmas/New Year….

I would say the booster probably knocked you off course, you certainly aren’t the first, and I doubt you’ll be the last.

Maybe when you do want to consider reducing again - try 1mg every 2 months (or 0.5mg every month if you prefer) and maybe a slower taper - see this link -

healthunlocked.com/pmrgcauk...

Good luck

[Ozark in reply to DorsetLady]

Thank you for the advice and the taper plans.

[PMRpro Ambassador]

Yes, and morning pain and stiffness is not uncommon even on an adequate dose if the antiinflammatory effect doesn't last a full 24 hours for you. It varies from 12 to 36 hours depending on the person. Some people find splitting the dose helps - taking the bulk, about 2/3, in the morning and the rest a bit later can extend the effect until the next dose is due.

What time do you take the dose? As mentioned, the inflammatory substances are shed about 4am - taking the pred either before (2am) or as soon as possible after 4am means it has less to do and the relief sets in sooner.

[Ozark in reply to PMRpro]

I have been taking my dose with breakfast in the morning. But I am an insomniac and morning for me can be anywhere from 11:00 a.m. till noon as I sleep in to compensate for the multiple times I awaken during the night. But I think I may have resolved this issue, as I said to DorsetLady in my above comment, I increasing my pred dose from 8 mg to 10 mg as of yesterday. I I got up today a new person. It would appear that just that 2 mg increase made all the difference. But as I said to DorsetLady I would rather be going in the other direction with my dosage and I don't know how long I'll have to stay at this new dosage before attempting another run to lower it. Who knows, I may be stuck here forever. I thank you for responding to my post.

[PMRpro Ambassador in reply to Ozark]

If you are awake so much at night - why not try taking the pred much earlier? The sooner you take it after 2am the less effect the inflammatory substances shed at 4am will have - and it often also means you get away with a lower dose.

Of course, it may well be you were on too low a dose - but the timing is also quite critical and a bit of experimentation is often very helpful.

[Ozark in reply to PMRpro]

My insomnia predates my acquisition of PMR and is unrelated. I've had difficulties sleeping since my late 50s and it has only gotten worse with continuing age.

[PMRpro Ambassador in reply to Ozark]

Doesn't matter WHY you have insomnia - but if you are awake, then you could try taking the pred sooner.

[Ozark in reply to PMRpro]

I've been suffering from insomnia since my late 50s, I'm now 78 and things have not gotten any better, only worse. Also, I'm a night owl. Most nights I don't make it to bed until 2:30 - 3:00 a.m., so the 4:00 a.m. dosing with pred to relieve morning stiffness would not really apply to me. I guess this prophylactic dose in my case would have to be taken about eight or nine in the morning seeing as how quite often I get up about 11:00 a.m..

[PMRpro Ambassador in reply to Ozark]

If you are awake you must be aware of when the pain/stiffness starts? In which case, taking the dose at least a couple of hours before that should work. What is significant is having it in place BEFORE, not playing catch-up. And before can be more than 2 hours before ...