PMR Flare-up after an increase in Pred dose

[redhouts]

As I mentioned in my last post I have both PMR and GCA, I picked up from here that was given a low dose of Pred and the reduction was also too fast, therefore my pain leaves have never reduced. I increase from Pred dose from 15mg to 25mg regularly over the past week. I left really well for the past week after the increase, however, today I have pain in my one shoulder, soft muscle in my upper arm, tingling in my face, and my thighs and puffy and burly eyes. I'm baffled as this feels like a flare-up of PMR, what could be the cause of this?

[PMRpro Ambassador]

Have you done anything different? The fact it is one-sided could suggest you carried a heavy shopping bag? Pulled at a heavy door? Took the dog for a walk and he pulled? Have you been eating salty food? That used to make me puff up when on pred. But with 25mg that really should take care of PMR - not necessarily GCA though.

[redhouts in reply to PMRpro]

Yes carried a bucket of water and may have had some salty food too. Would this also affect the thigh area? Thanks for the response, just so helpful.

[DorsetLady PMRGCAuk volunteer in reply to redhouts]

Why not? Carrying something heavish probably puts a strain on legs as well as arm/shoulder.

[PMRpro Ambassador in reply to redhouts]

You tend to lean to one side to compensate - and that puts stress on the rest of the back muscles, low back affects hips and thighs ...

[redhouts]

Indeed...

[redhouts]

Should I increase further to cater for GCA since you say 25mg should take care the PMR and to up dosage?

[PMRpro Ambassador in reply to redhouts]

Not unless you think you have GCA symptoms - and if you do, you need to speak to your doctor urgently.

[redhouts]

I was diagnosed for both PMR and GCA and was prescribed 25mg Pred first month, reduced over 2 months to 5mg and MTX after the symptoms didn't improved. Have been up and down from on 25 mg trying to reduce without success. I now realise it's too early to reduce so I want to find the right dose that will help reduce the pain and discomfort, while I wait for my next appointment with the physician.

[PMRpro Ambassador in reply to redhouts]

IF you really DID have GCA then you were started on far too low a dose - 25mg is PMR territory, GCA needs more like 40mg or often even more.

A study found that GCA patients started with the pulse therapy which is 3 days of infusions of 1000mg per day were subsequently able to reduce quicker and, despite the very high starting dose, had a lower total dose of pred in the end, There is no virtue in trying to cut the dose at the start.

[Susan1705]

I was diagnosed with GCA in June (already had PMR). I had the 1000mg for 3 days via drip in hospital. Then went to 60mg 50, 40, 30, 20 for 2 weeks each then down to 10 (2.5 each 4 weeks). Now on 9. Had a flair going from 30 to 20 so increased for a week. Apart from that GCA has been okay and PMR fine as prior to GCA was on 6mg

[redhouts]

Wow thanks. Now I understand why I'm not improving with my treatment. Will seek a 2nd opinion with different doctor.