Some advice needed please

[JEMOK]

I was diagnosed with PMR in Feb 2021 & started on 15mg pred. I am using the DSNS taper & am at 12 mg tapering to 11mg. I have had excruciating pain in my hip & buttock for 2/3 weeks & am unable to walk. My GP thinks it is probably bursitis & advised me it should get better on it's own. Should I increase my dose to help with inflammation/pain & if so by how much. Sorry for the long post

[PMRpro Ambassador]

That's not long - I'd have said it was on the brief side!

Hmm - I suspect your GP is right and wrong. I think it could well be greater trochanteric pain syndrome (new name for trochanteric bursitis) so he is right there - BUT, although it often does resolve on its own by avoiding the activities that make it worse, when it is part of PMR it doesn't always do so. The underlying autoimmune disorder that causes the PMR "feeds" the inflammation so it may be rather more difficult to get rid of. It also affects the piriformis muscle and if that remains tight/spasmed, it won't just disappear without some help.

nhsaaa.net/allied-health-pr...

guysandstthomas.nhs.uk/reso...

are two NHS handouts with exercises to try.

I find that an 800mg flooding dose of ibuprofen and heat over the painful area of the buttock helps relax the piriformis muscle. But it isn't a 10 minute application of heat - I have a hot water bottle over the area all the time I am sitting, though to be fair, when it is that bad, I have to sit as it is too painful to do anything else!!! For me the muscle spasms spread up into the lats muscle and across just below my waist - the Germans call it a witches shot, very suitable name!

I have had really good physiotherapy - but here they do it hands-on, unlike the NHS who would probably just give you the same sort of exercises I've given links for. I have also had shockwave therapy this last time - 3 sessions, the local rehab rheumy swears by it. Don't know if it is available on the NHS, or even in the UK, but it does seem to have improved things around the hip quite a bit though the muscles higher up my back are still niggling.

[JEMOK in reply to PMRpro]

Thank you PRM Pro for your response. I discussed your reply with my GP & he has agreed to give me a steroid injection into my hip on Monday which is amazing news. I cannot thank you enough for your advice & am looking forward to being able to walk again

[123-go]

For a GP to say to someone in excruciating pain, "it should get better on it's own" is bad practice in my opinion. How long does he/she expect you to suffer before something is done for you? Being unable to walk due to pain merits more prompt action.There are things you could try like ice and paracetamol but the latter may not make a great deal of difference. I believe steroid injections are used for trochanteric bursitis; I would ask the GP for this.

[JEMOK in reply to 123-go]

Thank you 123-go you are quite right paracetamol & ice make no difference at all but armed with PMRpro's advice I have managed to get my GP to agree to a steroid injection into hip joint on Monday so fingers crossed I will be walking again soon.

[123-go in reply to JEMOK]

Excellent! PMRpro is indeed a pro! Please let us know how things go.

[Nightingales]

Hello, it’s difficult to say not knowing what part of the hip is affected. Bursitis is excruciatingly painful to pressure on the bony side of the hip and the pain syndrome often goes along the top of the pelvis at the back and down the side or front of the leg often into the groin. An X-ray would be a first step I would think. This was one of my worst symptoms but steroid injections under X-ray or ultrasound guidance at the pain clinic worked well for me. Eventually I had RNA, radio nerve ablation which was highly successful for at least two years. But a recent flare has set it off and I really sympathise with you about the pain and difficulty walking. Hope you can get some relief soon. My GP gives me a few days Naproxen just to get me over the worst times but you shouldn’t take it for long with Prednisolone.

[JEMOK in reply to Nightingales]

Thank you so much Nightingales I will certainly keep in mind to discuss RNA with GP if the steroid injection doesn't work for me. Unfortunately due to previous perforation of duodenum I am unable to take any NSAID's which makes pain relief difficult.