Why do I still have inflammation?

[Broseley]

Just been to see an ENT doctor about my persistent sore throat. After an examination he said it's "just inflammation". This is the story of my life! The orthopaedic surgeon said the same about my hip, before I developed full blown PMR/GCA. I first got the sore throat when the other GCA symptoms developed, along with sore ears and swollen glands in my throat. The ENT guy said this is typical of GCA, contrary to the rheumy. When I was put on 40mg pred it all went away, bar a little bit of pain in my hip. When I went down to 30mg pred the sore throat came back and hasn't gone away since. Now I'm on 20mg and my hip is hurting more as well. My other symptoms have all stayed away, fingers crossed. However I have started snoring again! My question is why have I still got inflammation?

Btw, I discovered that it's even more difficult to understand a strong African accent when the Dr has a face mask on. I had to ask him to repeat virtually everything he said! So embarrassing!

[SnazzyD]

Inflammation is a sign of a problem that shouldn’t be waved off. There are numerous causes, all needing different treatments and with differing urgency. Simply, it might be thrush from being immunosuppression on these higher doses of Pred. It might be silent reflux because of the Pred and long term should avoided. As you say it could be heralding a flare especially since this was a pre diagnosis symptom for you. That alone ought to ring some alarm bells. Sore throats can be a sign of certain haematological problems, the list goes on. So, “just inflammation “ is a cop out. Your question, “why?” is valid.Re the snoring, have you developed the extra fat round the neck from Pred?

[piglette in reply to SnazzyD]

I would love to know why my CRP is always raised. I had the results of a blood test last week and CRP was 40. The receptionist said the doctor had written Satisfactory on my notes.

[Broseley in reply to SnazzyD]

Yes I think my neck is fatter. I'm a bit unusual in that I snore on breathing out rather than in!

[Broseley in reply to SnazzyD]

He did mention silent reflux. I'm on omeprazole though. He prescribed me Diflam spray.

[SnazzyD]

Just bear in mind that Difflam spray is symptomatic relief for the top end and won’t be protecting your oesophagus as a whole. You might try gaviscon, particularly at night, to see if it helps as a bit of a diagnostic aid, because if it does help acid might be the problem indeed. If that is the case, they need to give you more than Difflam. Some get on better with the less fashionable sort the H2 agonists like Famotidine or Cemetidine. Are you due to speak to the Rheumy soon because along with your hip getting worse too, you need a bit of a check on your disease activity and/or possible other cause.

[Broseley in reply to SnazzyD]

No, I am waiting for my next rheumy appointment to come through. I saw him in October so it's due for the end of Jan. I rang and asked the secretary she said they're way behind so I may have a long wait! Interestingly, I spoke to a friend last night who told me she has a friend on pred in Australia who has the same problem. She was told pred dries the throat and she has been prescribed a spray which imitates saliva.

[PMRpro Ambassador in reply to Broseley]

Have you thought of trying Xylimelts which stimulate the production of saliva overnight?

xylimelts.co.uk/

[Broseley in reply to PMRpro]

Thanks I'll try them.

[PMRpro Ambassador in reply to Broseley]

If you have dogs - keep the xylimelts away from them!

[PMRpro Ambassador]

I agree with Snazzy - that was just a cop-out, You have symptoms of something underlying it, what it is is difficult to say!Out of interest - what about your blood markers?

Thinking about it - maybe it is a mechanical thing for the sore throat: I have a post nasal drip that is the possible cause of mine. I don't take omeprazole but I'm not convinced it is reflux. It was definitely part of my PMR at the start, one of the several GCA symptoms I had. It does improve at higher doses of pred.

And the hip pain - where is it? Is it the right place for trochanteric pain syndrome: on the outer aspect of your thigh so it is uncomfortable to lie on your side? Oral pred isn't ideal to improve it and the PMR "feeds" it so the usual physio approach isn't ideal either - steroid injections do help much more and I have just had a technique called extracorporeal shockwave therapy which seems to have achieved something! The local rehab rheumy swears by it - we'll see!

[Broseley in reply to PMRpro]

Hi PMRpro. My bloods were last done in October when I was on 40mg, and they were normal. Not sure about my hip, as the ortho Dr wasn't really interested once he discovered no surgery was needed. My hip clicks all the time and the pain was mainly on rotational movement, stepping onto that leg or stretching forward with that foot behind. After a lot of research I think it's femoral acetabular impairment but I was told no. However it is a long standing if intermittent problem going back to when I was 18. He wasn't interested in that information. When it was at its worst it did hurt to lay on that side but I also had sharp sudden pain on the inside groin area too.

[PMRpro Ambassador in reply to Broseley]

The groin pain COULD be iliopsoas bursitis, an adjacent bursa. I had similar pain before pred and it took months before it faded and I have never had it again. I'd really wondered if I needed a new hip!!! Those sort of problems have also been longstanding for me - a really good physio might have some ideas.

[Broseley in reply to PMRpro]

Thanks. My physio is going with what the ortho said and has no ideas of his own!

[PMRpro Ambassador in reply to Broseley]

Hmmm. Is that an NHS one?

[Broseley in reply to PMRpro]

Yes!

[Sharitone]

I also have a long-term sore throat, particularly lying down, even though I am down to 14mg pred now. Just had a week's treatment for oral thrush, but the soreness is still there. It must be associated with dryness, so I shall also be trying the xylimelts! A colleague had GCA with pred-induced dry mouth some years ago; now the GCA is long in remission but the dry mouth is permanent. So I'm hoping that keeping the saliva going might possibly avoid that. My dentist gave me some biotene which works reasonably well, tastes nice, and has the advantage of being free on prescription.

[PMRpro Ambassador in reply to Sharitone]

If you have dogs - keep the xylimelts away from them!