Is it possible to have a flare up of PMR without a change in predisolone dosage?

[Springer2210]

I have had PMR for over 2 years & I'm currently on 12mg of Pred. I have seen a Rheumatologist & started Methotrexate on 15th September10mg once a week but I have not started reducing the Pred yet. For the last 4-5 days I have been feeling cold, tired & aching all over & feel like I've got the flu. Similar symptoms to when PMR was diagnosed.

Could this be a flare up? The only other thing I can think of is I had my second shingles vaccination on Wednesday 14th September. Looking on the internet these are symptoms experienced after having a shingles jab but should only last 2-3 days. I have spent most of this afternoon in bed asleep & I am now sitting with a fleece jacket on, a blanket round my legs & I am still cold & shivering. I've even thought of putting the heating on!

Any ideas what this could be . . . flare up/shingles jab?

I've done a Covid test, so it's not that! I'm off to make myself a cup of hot chocolate to hopefully make me feel better.

[HeronNS]

It could be a vaccine reaction, or maybe you have caught a cold or flu. However, to answer the question directly, yes you can have a PMR flare-up even if you are not tapering. The disease process can ramp up either because of some stress you can point the finger at, or for no apparent reason at all.

However, you started a new medication at roughtly the same time as you had your second shingles shot, so it may be a bit hard to sort out exactly what's going on. Provided your symptoms don't get worse (in which case you should seek medical attention) I'd be tempted to wait it out for one more day. It is possible that the MTX is causing at least some of those symptoms, in fact more likely than a delayed reaction to the vaccination. (I had strong reactions to both shingles shots, and actually to both Moderna vaccines I've had - 2nd booster and bivalent - and in all cases the reaction came on within a few hours and lasted roughly twenty-four hours, including after my bivalent shot yesterday the feeling that I had the flu with aches all over and feeling chilled for a few hours.) Have never had MTX so can't speak to that but I do know some people get quite an unpleasant reaction to it. It doesn't work for everyone if the idea is to help with pred taper.

[Springer2210 in reply to HeronNS]

Thanks HeronNS. I’m tucked up in bed at the moment keeping warm so I’ll see how it goes when I get up later. As you say it could be any of those things causing this so I’ll just have to ride it out as usual. Better days will come.

[HeronNS in reply to Springer2210]

Hope you are feeling better. However the caution regarding unreliablity of RATs should be heeded. I follow Twitter and there are frequently people posting that they didn't get a positive result until the third or fourth day of feeling ill. It may be something to do with the viral load. My husband had covid in April and for his first RAT the line was very faint, but did get stronger as we tested eve@ry couple of days. He finally tested negative again on the twelfth day, although he felt mostly better days before that. I think he was sick for a day before I suggested he needed to test! But fingers crossed this is not your situation and you are well soon!

[Springer2210 in reply to HeronNS]

Thanks for info HeronNS. I will do another test tomorrow although I felt a bit brighter when I got up this afternoon. I’ll see what tomorrow brings.

[PMRpro Ambassador]

First of all - the LFTs are very unreliable with Omicron. My daughter had symptoms for 3 or 4 days before she got a positive - and that was using a different batch when she got a positive with one and negative with the other! Just saying ...

Yes, even without having a jab - which can disrupt your immune system for a few days - it is possible to flare without changing dose because the underlying autoimmune disorder seems to fluctuate a bit itself. I think it cycles and if you made a graph of the activity it would show something like a sine wave. If you reduce on the way down you might be fine for a while but then it wakes up a bit and suddenly you aren't.

Sounds like a bit of bed, warmth and TLC is called for. But don't discount it being a virus - Covid or something else. Or the MTX.

[Springer2210 in reply to PMRpro]

Thanks PMRpro, I’ve taken your advice on the TLC & am tucked up warm in bed. Will try getting up later & see how I feel.

[Oboes22]

I had symptoms and felt really I’ll for a couple of days before I showed positive for covid so keep testing. Hope you feel better soon and take care.

[Springer2210 in reply to Oboes22]

Thanks Oboes22. I’ll re-test again this afternoon if I’m not feeling any better.