PMR return? flare or ?

[suzieh]

Painful shoulder & arm. PMR return or Rotator cuff injury?

Started to hurt mid Dec. Only in right side

However both elbow joints sore when pressed

Dr- 2 x so far. Bloods all normal. ( prev when I had PMR blood markers not raised much but in so much pain dr prescribed steroids- pain gone)

Dr 2nd visit- thinks not PMR as only one side, suggested Rotator cuff problem & has requested a hospital scan : possible steroid injection (during scan if needed) says appt should be in 2 weeks

I’m on hol at present-in the sun - have got leftover pred with me(5 yrs old) would a low dose get rid of pain? For a few days?

I know it’s not great to self med but this am my arm :shoulder is really sore- sleep awful. Have taken some ibruprofen but doesn’t seem to touch it

( naproxen from dr - with me but reluctant to take as after 5 days post Xmas didn’t seem to help but caused constipation)

Advice please?

[DorsetLady PMRGCAuk volunteer]

Possibly PMR return - but would agree with Dr does sound as if rotator cuff.

As your bloods weren’t high previously, that’s no real indicator.

Are you saying Pred is 5 years old, or you had PMR previously for 5 years - if the former, doubt there much ‘oomph’ left in them…

PMRPro does sometimes suggest a flooding dose of ibruprofen- sure she’ll be along shortly - but you could also try gel on affected parts that’s sometimes more affective.

Might be worth try some gentle exercises - have a look on YouTube, but only gentle!

[suzieh in reply to DorsetLady]

Thank you for reply- feeling less painful now it’s pm. Am doing rotator cuff exercises several times each day. Google says pills ok for upto 10-15 yrs after expiry - usually?

[DorsetLady PMRGCAuk volunteer in reply to suzieh]

Really….that’s very unusual….maybe if they are kept in perfect conditions….If that’s the case you could try them I guess, not sure I would though…suppose it depends how desperate you get…

[PMRpro Ambassador in reply to suzieh]

It depends - kept in ideal conditions and certain drugs, possibly. As a general rule - not a good idea.

[PMRpro Ambassador]

I really really wouldn't take 5 year old pred - it will probably be way past its expiry date and it also depends on storage conditions.

With ibuprofen you really need what is called a flooding dose: 800mg in a single dose which is at least double the usual dose. That was how it was to be used - and the manufacturers were furious at the 200 or 400mg doses that were recommended when it went OTC because they often don't work for moderate pain. After that flooding dose you go back to more normal dosing but I find it lasts quite a long time, often 20 hours before I need more.

[suzieh in reply to PMRpro]

Dr gave me 1000g Naproxen per day. After 5 days- constipated! So stopped. Didn’t feel much different pain wise. Have resisted taking my old pred. Now it’s afternoon the pain is going off. Just so awful in the morning. Maybe being on hol will help !Thanks for comments though.

[PMRpro Ambassador in reply to suzieh]

Naproxen will do nothing for PMR.

Have you access to hot water bottles or - even better - an electric blanket to warm yourself up BEFORE you get out of bed. Then do gentle stretches in a hot shower. Once you start to move it should improve things, it was how I survived for 5 years with untreated PMR. My best days were when I had an aquafit class at 9-ish - if you have access to a warm pool where you are on holiday get in it and use that to get moving. Don't get too enthusiastic, every action in water takes 7x the effort it does on land so very easy to overdo it and suffer the next day. even just walking in the water should help and standing in one spot and moving from side to side will make a difference.

[suzieh in reply to PMRpro]

Thank you. Very good suggestions- I’ll try. Currently much easier this pm. Expect it will be worse again am

[HeronNS in reply to suzieh]

I was in denial about a painful shoulder last year. I was even in denial regarding much higher CRP, was convinced the shoulder was caused by other factors, and that the increased inflammation could have been due to my injured knee. Eventually I gave in and took 10 mg pred - had been hovering around various doses lower than 5 for some time. Miracle! Now, my pred was "fresh" and I do agree with the others that taking any medication more than 6-24 months past date is not a good idea. Some medications actually increase in potency, although I doubt pred is one of them.

What I really mean to say is your experience of Naproxen not working is a bit of a telltale sign that it well be PMR again.

A holiday may help. Before diagnosis I gave myself a retirement gift of a week in the UK visiting my cousins. It was November (we saw the poppies at the Tower) so can't claim balmy weather helping. But getting away from a stressful situation at home must have made all the difference. I'd been worried about being semi-crippled from lugging suitcase, heavy backpack, etc. My hotel room wasn't ready (I was spending first night alone in London) so I ended up walking around all day with a heavy backpack). You know - I was absolutely fine for the whole time I was away!

[HeronNS in reply to suzieh]

I should add that my troublesome shoulder which responded to pred (but not to exercises or other medication) was right side only. I have a strong suspicion that had I left it untreated the other shoulder would eventually have joined the party. This was all taking place over months last year. From highest CRP reading ever it is now lowest ever - normal for the first time since started testing regularly in 2015! I've done nothing else different for my shoulders regarding exercise, etc.

[suzieh in reply to HeronNS]

Thanks for reply. Really helps hearing different experiences. I’m fortunate to be on hol-somewhere warm, good chance for a rest & to monitor what is happening

[Moness]

Sorry to hear about your shoulder. I’ve had a rotor cuff problem for years but unfortunately Pred doesn’t seem to help neither has physio. Cortisone injections have worked temporarily. I just have to be careful not to aggravate it and the medics are still looking into it - this isn’t very positive but I do hope you have better luck with yours!

[suzieh in reply to Moness]

Thank you for reply. Today feels a little better but I know this is up and down-

[Moness in reply to suzieh]

Just be very cautious about how you move your arm, cleaning for example is a killer for mine (good excuse not to !) and even putting a coat on. I wish you well with it all and hopefully it will respond to the excercises.