pmr flare

[Skier321]

Hi again I wrote about 2 weeks ago. Was at 4.5 mg of prednisone started to stiffen up. Had reduced from 10 mg by doing .5 mg per month. As per flare guidelines I went to 9 mg for nine days then 7 mg for 5 days so I could go back to 5 mg where I was last fine but at 7, I am still stiff and sore in my lower back and left groin area. Very frustrating and depressing. Do I need to go back to nine now and start reducing by .5 mg all over again? I feel like I have lost 10 months of good work. Your thoughts and suggestions.

[DorsetLady PMRGCAuk volunteer]

You probably do need to go back to 9mg- but you can stay there for 14 days with jeopardising your resultant taper. Then try 7mg again- hopefully this time around it will work..

[Skier321 in reply to DorsetLady]

if I go back to 9mg for 2weeks then drop back to 7mg how long would I stay there before going below 7mg and then try to go to 5mg or start a new taper .5 mg per month? Thank you for your thoughts

[DorsetLady PMRGCAuk volunteer in reply to Skier321]

At least a week, maybe two . Depending on how you feel after that -then either to 5 or 5.5mg [provided you feel okay] - but you are in the realms of adrenals needing to re-awaken, and for some that can be tricky….so no rush. I know it’s disappointing, but going slower is better than too fast and risking another flare.

[jls93]

In addition to previous comments.

If the groin area discomfort is toward the front then there is a good chance it is more likely hip. That being said, it would also contribute to your low back issues. Your issues being on one side would also contribute to this logic train. Remember that the normal demands on on glutes and lateral hip musculature are 2 x's our body weight with each step we take because of the biomechanics. Also, the left side maybe additionally loaded because of weak right hip and reflect a compensatory strategy. Remember that your legs connect your back to the ground and our hips are the first link in the lower extremity chain( back >pelvis>hips>knees>ankle> feet). Sadly but truthfully, deconditioning and weakness occur at what seems to be an alarming rate. Personally I must remember that when I exercise, I am reminded ( daily) that I am training the body I currently have, not the one I wish to have.. Training not Trauma. We train our muscles and not "train" joints ( protect joints while exercising muscles). Adaptive muscle training is more skillful that we may think... Hope this helps. Sorry if too wordy or technical... no dis-courtesy indented. Success breeds success. Be well ...sincerely

[Skier321 in reply to jls93]

thank you for your thoughts. It is appreciated. My left side groin is where my PMR first started. My left lower back I believe is the result of a hip injury I got a couple of weeks ago. I also aggravated it helping my neighbour with a fence. I probably still have that sore hip and back. Too much inflammation from injury and Pmr caused this flare. Hard to know how to deal with. I am glad I have this support group. My doctor is really good he understands the difficult balancing act this disease and prednisone present and tells me to listen to my body. I am seeing my physio on Monday who also understands PMR will get some new exercises and stretches for hip and back. Thanks again

[PMRpro Ambassador]

Don't forget you are NOT heading relentlessly for zero. You are looking for the lowest effective dose - you find it by identifying where the symptoms return. and you seem to have done that. You don't need to feel you have lost the last 10 months, they were an essential part of the process.

And have you done anything that could aggravate a lower back problem? It sounds a mixture of slow to respond adrenals, too low a dose for the PMR and overdoing something.

[Skier321]

thank you for your thoughts PMRpro I sometimes think the emotional side of dealing with this disease is almost as difficult as the physical side. You feel like you are playing the game snakes and ladders

[Skier321 in reply to Skier321]

yes I did injury my hip 2 weeks ago that stated all this too much activity now too much inflammation

[PMRpro Ambassador in reply to Skier321]

So I have just seen - I think that has a big part to play in your situation.

[Skier321 in reply to PMRpro]

thank again all. My problem now given that an injury caused the flare how much prednisone do I take to control the pmr while at the same time not taking to much to mask the injury. Also given that both create inflammation. In a perfect world I would only like to take enough for the pmr and deal with the injury as I would in the past with ibuprofen, stretches and time. I guess lots of folks are in this position with injuries and surgeries. Appreciate your thoughts on this. All was good before the injury at 4.5 mgs

[PMRpro Ambassador in reply to Skier321]

Sorry for the delay replying - I've been away.

I don't think pred will "mask" an injury - I never really know what people mean by the term in relation to pred. Injury takes time to heal - paracetamol should work as well to blunt the pain.