More guidance needed please

[Callymac]

At the end of October I asked all you helpful people for advice about a flare after having Covid and flu boosters. I had been on 2.5 mg of prednisolone for a while but was having quite a lot of pain in my shoulders. A fortnight ago I finally saw my GP for the first time since the PMR diagnosis over 2 years ago. He suggested increasing my dose to 7.5mg and then staying on that dose for a couple of months before starting to slowly taper again. . After two weeks things are better. My left shoulder is only slightly inflamed but my right shoulder is pretty sore. I did have rotator cuff issues with the right shoulder 3 years ago long before the PMR started so am not sure whether that is the same problem recurring again or if I should be increasing the prednisolone dose up to maybe 10 mg to see if that helps. I get woken around 4 or 5am every morning with pain in the right shoulder. Any advice would be gratefully received.

[123mossie]

Hi I understand your dilemma with the rotator cuff. It could well be that again. There are specific exercises that may help, it might be worth seeing a physio. If it doesn’t settle, the gp can assesss you to see what’s going on. When I had this (pre pmr) I was given an h/c injection which lasted a good 10 weeks.

[Callymac in reply to 123mossie]

Thanks 123mossie. I’ve got a physio appointment next week with a lovely lady so will see what she says.

[SnazzyD]

Its a tricky one and somebody needs to examine you really. After a long spell of Pred the muscles and ligaments can become very susceptible to injury from not much. Is there anything you do that is repetitive, frequent or strenuous (lower your bar for what you consider strenuous here!)? What do you do a lot of in the day? Are you left or right handed? Two years isn’t long for PMR so it might be that you need to back track on dose a bit, though I always suggest getting one’s physical ‘housekeeping’ up to scratch before just assuming that the issue is 100% IT.

[Callymac in reply to SnazzyD]

Thanks SnazzyD

Good advice. I’m one of these people who need to be busy all the time so as not to sit about getting anxious about stuff. Gardening, golfing etc. Family keep saying you’re doing too much. Need to turn my attention to less strenuous activities and be more sensible.

[SnazzyD in reply to Callymac]

Ooh goodness, that would do it. Know what you mean though. I didn‘t have PMR, just GCA and the Pred effect alone meant I couldn‘t garden for a while and that nearly killed me.

[PMRpro Ambassador]

I agree with Snazzy - I think you need other things to be ruled out and probably some physio assessment too. Our system here covers both - to have physio you are first seen by a rehab-trained doctor, usually a rheumatologist, who decides on the most appropriate management. In your dreams I know - but an x-ray and physical examination is essential I'd say.

[Callymac in reply to PMRpro]

Great advice as always PMRpro.Thanks. The physio I’m seeing next week has helped me in the past and has some knowledge about PMR. I’ll be guided by her and then I’ll maybe go back to the GP if exercises don’t help