Reduced prednisolone - rapid onset of discomfort but ? PMR or coincidence - what dose next?

[liz6620]

To update from my history, I reduced pred to 5mg daily (taken after breakfast) on 13.2.23. About 2 weeks later I developed some return of stiffness in shoulders/neck/pelvis and this increased a little into March. By 10.3.23 I also developed lower back pain and my left hand seemed puffy and very sore (on the palm side). Rightly or wrongly I perseverred at 5mg and lower back and hand problem cleared after about 5 days. My end of March blood test showed ny usual level of CRP, which has always run slightly higher than for most people even in the years pre PMR/GCA.

I had my 7th vaccine last Friday, took MTX the previous day as usual but plan a 2 week break now as advised. No major reaction to the vaccine, just a bit weary on Saturday and a large swollen itchy bump about 2" across at vaccination point. That's much improved today.

By coincidence, and with hindsight probably foolishly, I reduced my pred to 4.5mg daily on the day of the vaccine to start my next long overdue (according to hospital and GP) reduction.

On Sunday my left hand was slightly sore, increasingly so now and my hand is puffy and I find gripping a pen or picking up a kettle for example difficult. I am left handed. My left sacro-illiac area is a problem today, increasingly so. No increased stiffness in usual,PMR places though.

My GCA was ultrasound and biopsy proved March 2020. I never had any of the usual symptoms luckily, just some occasional mild jaw claudication. I may have a little of that now too.

So my question is what dose of pred tomorrow may be advisable as I feel developing the hand/back problem twice with reduced pred is a sign of something. How long do I take the increased dose and when do I try a reduction again? If I email my hospital help line tomorrow I may or may not get any advice and it may just be to increase to very high levels to give "belt and braces advice". I'm not sure that would be the most informed decision but would appreciate your knowledgeable and experienced thoughts please.

Apologies this is lengthy.

[DorsetLady PMRGCAuk volunteer]

If it were a flare then this link contains information on how to deal with it - but not sure is a “straightforward” flare.

healthunlocked.com/pmrgcauk...

Not convinced your issues fit into that scenario - but it might be worth considering whilst you await medical advice.

[liz6620 in reply to DorsetLady]

Thank you DL. I will try that tomorrow to see if it helps. Lets hope so. As you say my current symptoms do not seem to fit the usual pattern for a PMR breakthrough.

[PMRpro Ambassador]

I agree with DL. You can only try - and if it is a minor flare, best not to let it get away.

[liz6620 in reply to PMRpro]

Thank you PMRpro. I realise having mostly erred on the side of caution in the past, I seem to have been rather foolish and have tried the reduction at an inappropriate time. This is all such a learning curve.

[PMRnewbie2017]

So all this happened after your 7th vaccination? I realise I'm beginning to say this in a lot of my posts these days but have you tried taking some Paracetamol. You can safely use it with MTX. It really is underrated. Swellings around injection sites are not uncommon. I'm wondering if the hand swelling is related to the vaccination. It would be a rare complication but I have heard of it before. At least if Paracetamol does nothing ( I would take it for 24 hours, max 2 tabs every 6hrs) then you have some useful information to pass on to the Rheumy.

[liz6620 in reply to PMRnewbie2017]

Thank you. I don't believe this is as a result of the 7th vaccine at all. I think the reduction in prednisolone was poorly timed by me at much the same time as having the vaccine and that the pred reduction is where my issues may lie. Something similar but less painful happened on my previous steroid reduction. The vaccine was done in my right non-dominant arm, the hand issue is in my left hand. So again no link at all.

Thank you for the paracetamol advice and I did take 2 last night and will take more if necessary today.