PMR flare or not so gentle yoga?

[SandyBoots]

Greetings,

I have had PMR about 2.5 years now and managed to taper off prednisone summer of 2021. I realize that is a rather short amount of time to be on prednisone. I have not really had any pain since then until this last week when my shoulders and neck started feeling stiff and painful again. It is not as bad as when I was first diagnosed with bilateral pain in my shoulders and thighs. I have been wondering if maybe if I just strained them since I went to a gentle yoga class a couple weeks ago that was not so gentle. I thought I would wait it out a bit before talking to my rheumatologist to see if it passes, but i worry about brewing inflammation. I kind of live in fear of GCA and my question is if you allow inflammation to "simmer" do you up your chances for developing GCA?

Thanks for your wise wisdom

[DorsetLady PMRGCAuk volunteer]

If from Yoga, a couple of weeks should have been long enough to settle - have you tried painkillers or heat/cold therapy to address? If not, then try..you soon find out if that helps.

As for leaving inflammation to simmer, doesn’t necessarily mean it will be GCA rather than PMR, , just means it will take longer -and maybe a slightly higher dose to get under control.

It may have already been lingering, and the yoga was the nudge it needed to resurface enough to cause a problem.

[autumnlass in reply to DorsetLady]

Hi DL.I was interested in your last sentence about the ‘ PMR lingering and the yoga was the nudge it needed to resurface enough to cause a problem’ …… I had been on Ramipril for hypertension as it caused a continuous dry cough and gastrointestinal issues …. Could the gastrointestinal problems have triggered a current flare that started about 11 days ago? Would be interested to learn. PMR started 18 months ago and was down to just hitting the 7.5 mgm mark when this all occurred…. Or is it just a coincidence? Thanks 💐

,

[DorsetLady PMRGCAuk volunteer in reply to autumnlass]

Could be the gastrointestinal issue - unfortunately we sometimes we never know what causes a flare, or the original disease - anything that stresses your immune system can be the catalyst.Wish I could give a definitive answer, but not sure there is one. 😊

[autumnlass in reply to DorsetLady]

I guess that’s the nature of this ? enigmatic disease!! Thanks DL!

[PMRpro Ambassador in reply to autumnlass]

You do have to remember that you aren't heading relentlessly for zero pred - you are looking for the lowest effective dose and the lower you get, the nearer you are to that dose. Even 1/2mg can be the difference bewteen enough to control the inflammation caused by the current disease activity and not - and PMR/GCA is most active in the first 18 months. Overshooting the dose is the main reason for a reappearance of symptoms - not because the disease is more active but because the pred is not enough.

A true flare happens when you have been stable on a dose for a while and suddenly something pokes the immune system again. Strangely Prof Mackie and the other rheumies on the research group found that difficult to comprehend - they didn't think that disease activity would increase when a patient was on pred but I think almost all of the patients involved in the group had experienced it.

[autumnlass in reply to PMRpro]

… A true flare happens when you have been stable on a dose for a while and suddenly something pokes the system again ……. this is exactly what happened to me! On 8 mgm from April ‘21 to Jan ‘22 when started to taper to 7.5 mgm - all went ok but the Ramipril started to cause the GI symptoms after taking it for 8 weeks .. just before the end of the taper in February ‘22!

Pred is jacked up to 15 mgm for 2 weeks ending on Thursday when I give progress report to GP. It’s mopped up most of the inflammation … and just had some Acupuncture! Ouch!

[PMRpro Ambassador in reply to autumnlass]

Mind you - even 1/2mg can be enough to let in a flare!

[autumnlass in reply to PMRpro]

Well it looks like the crafty so and so did hop in!

[PMRpro Ambassador]

Is it stable/improving at all or getting worse? As DL says, if it was the yoga you would think it would be improving by now. Although it sounds a bit like myofascial pain syndrome is for me if I insult the muscles affected and it can take a while to improve - and may not without the right approach.

No point being in fear of GCA - just be aware of the possibility.

[SandyBoots in reply to PMRpro]

Thanks everybody for your thoughtful responses. I went ahead and sent my Rheumatologist an email. I am usually a high energy kind of person and feel rather low these last few days, so i think there is some inflammation brewing!

[cranberryt]

My original PMR was triggered by not so gentle exercise (plus general life stress). So like PMRPro said I would wonder if the yoga just revealed what might have been brewing under the surface. It’s probably time to see the dr. and run some bloodwork as a first step.

[cranberryt]

I also meant to add that if the GI symptoms continue, get them checked out! I had persistent issues for the past year and finally got a referral to GI. Was dx with celiac and microscopic colitis. Celiac is another autoimmune and more likely to develop if you already have an autoimmune like PMR. I am still waiting on my follow up about the colitis. If you don’t improve, get it checked out as it can be more than just something you ate!

[Telsey]

Sorry to hear that symptoms arising. I am not sure. Time will tell. If it lasts I would check with doctor. They have blood work to detect inflammation.A sed rate and crp. C reactive protein. But unfortunately I have had symptoms even though my blood work was slightly high. Take care.