PMR flare, muscle pain or side effects of medication?

[sewinggranny]

I reduced prednisolone from 11mg to10mg a fortnight ago. Not been feeling great for the last week, I'm not sleeping very well, I am struggling to turn over in bed and to get out of bed, but the pain and stiffness are mostly in my right hip, my lower back and my chest. I thought it was a muscle problem initially and have been taking paracetamol but the pain is still there so I am now wondering whether it is a flare and whether I should try increasing the steroids. Tapering had been going well. My starting dose was 20mg in June 2022.

I saw a GP for a medication review yesterday. He said my chest is clear, oxygen levels are good, recent blood test was normal but my blood pressure is going up, 151/91 in spite of being on the maximum dose of lercanidipine. My feet and ankles are swollen and I was told to stop lercanidipine and change to Ramipril. I've read that lercanidipine can cause chest pain at maximum dose, I never had any problems with blood pressure until I was put on steroids.

I feel as if it's a vicious circle, each medication seems to cause more side effects which in turn lead to more medication and more stress and anxiety. I would be grateful for any advice.

[DorsetLady PMRGCAuk volunteer]

I would agree it certainly sounds like a flare - this link contains the usual advice for getting things back under control - and depending on when your last blood test was done it might have been okay- but as we know they are apt to lag behind symptoms.

healthunlocked.com/pmrgcauk...

Unfortunately steroids can cause a rise in blood pressure….and you may need more meds to help the swollen ankles/feet which can be attributed to higher BP - but do rest with them elevated as much as you can…and see if that helps.

[sewinggranny in reply to DorsetLady]

Thank you for your reply. Blood test was Feb 3rd, reduced to 10mg on Feb 2nd. I've read the link about increasing steroids. Do I go back to 11mg or does the fact that I have been having problems for a week suggest that I need to increase by 5mg?

[PMRpro Ambassador in reply to sewinggranny]

I'd see if the 11mg works first - if it doesn't, take the extra 5mg for a few days

[sewinggranny in reply to PMRpro]

Thank you, I will try that. Cardiologist I saw in October suggested I would be off the steroids in 6 months!

[PMRpro Ambassador in reply to sewinggranny]

In his dreams!!! Obviously not at all up in rheumatology is he!!!

[PMRpro Ambassador]

Go back to the dose you were good at. You may need a "clear out" as DL has explained with the flare link.

Remember you aren't heading relentlessly to zero - you are looking for the lowest effective dose at any given time and that tends to be higher in the early months than it will be later.

[violetsnowdrop]

I was on Ramipril for some time until 18 months ago. All the advice I can give is be careful with high potassium foods (e.g. bananas, brazil nuts) as Ramipril seems to attract potassium. I wasn't informed of this and had an overnight stay in hospital (on drips), with hyperkalaemia (excessive potassium). The hospital specialist took me off straight away.

[sewinggranny in reply to violetsnowdrop]

Thank you very much for the advice, I love brazil nuts and bananas I will have to limit them in future, the only thing I'd read was to take care with alcohol.

[MrLogical]

Sounds like a flare. Ask GP for a CRP/ESR test. Try higher dose of Preds as DL and PMRpro suggest.

[sewinggranny in reply to MrLogical]

Thank you the advice. Blood test booked for next week.

[MrLogical]

It would be good idea to check Hb (haemoglobin) levels as if it is too low then you may have anemia of inflammation ACD i.e serum iron low and eleveted ferrentine, this is good indicator of chronic inflammation as CRP/ESR can sometimes be unreliable. Request test for Iron studies. If you do have ACD and low Hb then you may fee additionally tired etc. ACD is automatically treated by increasing Pred dose for PMR. Check with your GP

[sewinggranny in reply to MrLogical]

Thank you