TAPERED TO 2mgs/ OA ACHES RETURN / PULLED NECK MUSCLE PAIN/ GCA or OA?

[Tarym]

Finally arrived at 2 mgs in February after 6 weeks at 2.5. Noticing my familiar OA twinges returning that must have been masked by Pred, - knees, finger joints, wrists. I have an appointment with GP in 3 (!) weeks to discuss knee, first X-rayed in 2005 for OA.

Ten days ago (approx) woke up with a pulled muscle in my neck, about 6 days ago started to get neck ache / discomfort when waking which clears in a few hours, but returns in the evening when I’m tired. Two paracetamols control these aches but I’m really worried if I should be considering GCA?

I did have a fall in 2020 just prior to PMR starting, X-ray to shoulders showed -

LEFT. There is increased distance and slight malalignment of the acromioclavicular joint in keeping with Rockwood grade 2 dislocation. The glenohumeral joint is intact.

RIGHT. Moderate acromioclavicular joint osteoarthritis. The glenohumeral joint is intact.

In addition I had an ultrasound scan of my neck in September 2021, after noticing a lump on the right hand side of my neck near the sternum, which confirmed evidence of OA in the right sternoclavular joint. (This has so far given me no pain).

Should I be thinking OA rather than GCA or a flare?

[PMRpro Ambassador]

I don't hear anything that suggests GCA - why do you think a pulled muscle is GCA rather possibly a sign of PMR that isn't well controlled?

[Tarym in reply to PMRpro]

The ache / discomfort goes up to the base of my skull, rather like a head ache.

[PMRpro Ambassador in reply to Tarym]

Tight shoulder and neck muscles can cause that as well - have you tried heat on the achey area? Do you have any other symptoms?

[Tarym in reply to PMRpro]

No I don’t have other symptoms, just going into week 3 of my taper and it seems OK apart from the recognisable OA niggles. Haven’t tried heat but I’m keeping my neck warm with a thick scarf! Will look out my heated pad now.

[DorsetLady PMRGCAuk volunteer]

Agree with PMRpro’s assessment - OA pains resurfacing…..and the head/neck pain much more likely to be that as well.

[Tarym in reply to DorsetLady]

Thanks to you both for the reassurance, it really helps to reduce the anxiety! When you live alone you really need to be able to share worries with those who really understand.

[SnazzyD]

Hello, in addition to what has been said, whatever the cause, it’s s good idea to watch your posture, especially as muscles get weaker. I’m always bleating on about the sternokleidomastoid muscles because tension here can cause GCA-like symptoms as well as being unpleasant. The YouTube video shows the anatomy of it in a brief way that really explains why it can cause so much trouble. The second link is writing rather than pictures.

youtu.be/eD3Ds3GIt9M(Not working as expected?)

healthline.com/health/stern...?

[Tarym in reply to SnazzyD]

Thanks so much for the information, it does help me understand what’s going on.

[HeronNS]

I understand why you may be in doubt. Hopefully it is OA. However I thought the same when I had bad neck and shoulder issues in early 2021. It wasn't until the evening I thought I should wear a scarf to bed when I remembered this was *exactly* how I'd felt in the later days of undiagnosed PMR before pred. I took an increased dose of pred (10 instead of what I'd been taking at the time, I think it was 3) and the effect was nearly miraculous. From that reaction and what has happened since then it seems clear to me it was a PMR flare, and quite a serious one. I do have bad OA in my neck. But two years later at a dose which is now hovering between 2 and 1.5 I have (touch wood) no neck or shoulder issues. Before taking the extra pred neither exercise or physio interventions had helped as I worked with what I thought was OA.

I should add that I didn't stay at 10 for long, only a few days, and for a while was around 7 - 5 before eventually able to taper to old low dose again, which took some months.

Just posting this experience in case it helps you determine exactly what's going on with you. Best wishes!

[Tarym in reply to HeronNS]

Thanks for that information, I’m just into week 3 of tapering so I’ll certainly monitor it very closely. I hadn’t given much thought to the fact it could be connected with a flare, it’s good to have heard your experiences.

[HeronNS in reply to Tarym]

Do let us know how you feel as time goes on. The fact that paracetemol seems to help is, PMRwise, a good sign, but best to be aware if it doesn't seem to get better. If I needed to take aspirin for a headache (I've always avoided taking NSAIDs for OA and acetaminophen - paracetemol - doesnt do much for me) it used to help the neck and shoulders, but not completely. Not like the pred! I was actually surprised the pred worked so well as I really didn't think it could be PMR after so long successfully at a low dose.

[Tarym in reply to HeronNS]

Thanks for pointing that out, I’ve been relatively lucky with my tapering so perhaps I must seriously consider whether 2 mgs is too low at the moment. I was fine at 2.5 so maybe that’s a good dose for me, I don’t want to risk messing things up at this stage! All the replies have helped me look at things more calmly and constructively!