Dropping to 5mg prednisone, just 5 in the AM. And hand xrays show mild osteoarthritis

[sdowney717]

I do also now have an orthopedic hand specialist appointment on Sept 2, my PIP middle finger joint right hand hurts a lot and cannot straighten it out all the way. I suppose I could have trigger finger and OA at the same time. Steady dropping of the pred is not bringing back any PMR pains, I do notice with every drop it feel it in my bones for a few days. 

[sdowney717]

Here is the right hand xray review by a doctor. Left is similar.

--------------------------------------------------

Impression

No acute findings. Mild osteoarthritis.

Today's exam was dictated using fluency dictation software (voice recognition software). Occasionally, sound-a-like computer induced dictation errors will populate the report.

INTERPRETING PHYSICIAN: xxxxxx, IV, MD

WCH//Report ID: 3096102

Creation Date: 07/05/23 3:28 pm

Narrative

EXAM DESCRIPTION:

XR HAND 3+ VW RIGHT

ACCESSION:

DX23-01485077

COMPLETED DATE/TIME:

7/5/2023 1:52 pm

REASON FOR EXAM:

Polyarthritis, unspecified

COMPARISON:

02/23/2023

TECHNIQUE:

Three views right hand

REPORT:

There is normal bone mineralization. Mild osteoarthritis in the distal interphalangeal joints and mild joint space narrowing with small osteophytes at the 1st and 2nd MTP joints. Mild osteoarthritis at the 1st carpal metacarpal joint. Soft tissues are unremarkable. No cortical erosion or fracture.

[sdowney717]

5 has been tough, I take some Ibuprofen to compensate.

[DorsetLady PMRGCAuk volunteer in reply to sdowney717]

5 has been tough, I take some Ibuprofen to compensate.

What exactly do you mean 5 has been tough - tough on what - PMR or OA?

If PMR, then you may need more Pred, if OA then really shouldn't be taking oral ibuprofen on a regular basis alongside Pred unless okayed by doctor, and you are on a stomach protector. Topical gel may help - but again need to be used sparingly.

Have you tried Flexiseq - non drug so no issue with Pred - if available in US -

flexiseq.com/

[sdowney717 in reply to DorsetLady]

RA asked and I told him I have been taking Ibuprofen for months, wanted to know how much, then said OK.

In fact, so far only one doc, my PCP does not like Ibuprofen in the amounts I was originally taking before I saw him, but was ok with it taken with Prednisone in small amounts, like my RA.

What has been tough is the drop from 7.5 to 5 of prednisone having more aches and pains pretty much everywhere, but I am determined to get off of it . I do not have typical PMR pains anymore.

My biggest pain problem at the moment is still my right hand middle finger. Makes me want to ask them to just CUT OFF my right middle finger as it is useless. The other fingers are good on the hand, just that one finger is a huge impediment to use of the hand for normal stuff. I have read they can do a joint fusion. I don't see why I need that finger. It prevents me from having any real grip on the hand, I can not open jars, bottles, etc... I cannot pull it in without lots of pain and it has gotten worse the last 2 weeks.

[DorsetLady PMRGCAuk volunteer in reply to sdowney717]

What has been tough is the drop from 7.5 to 5 of prednisone having more aches and pains pretty much everywhere, but I am determined to get off of it . I do not have typical PMR pains anymore.

If you are having more aches and pains everywhere how do you know some of them aren’t typically PMR?

So long as medics are okay with ibuprofen, fair dos…

[sdowney717 in reply to DorsetLady]

Some of them might be PMR related. They just have very low intensity compared to my first diagnosis of PMR which was excruciating. Plus my CRP fell under 10, which makes me think the underlying PMR went away and now it is just cortisol insufficiency for a time.

[DorsetLady PMRGCAuk volunteer in reply to sdowney717]

Plus my CRP fell under 10, which makes me think the underlying PMR went away and now it is just cortisol insufficiency for a time.

Unfortunately you won’t know if your PMR has “gone away” until you have been off Pred for a number of months and you have no return of symptoms….the CRP reading only shows the Pred is controlling the inflammation aspect of the disease - not that the one has gone.

[sdowney717 in reply to DorsetLady]

sure enough could be. Dropping down the prednisone though has a bonus effect for my insulin use and diabetes. I am testing a home made finger splint, seems to be straightening my middle finger, still hurts on a 3 level. I ordered a pair of splints that look long enough to fit a middle finger. Will see the hand specialist on Sept 2.

amazon.com/dp/B0BY26R1YC?ps...

[PMRpro Ambassador in reply to sdowney717]

If you are on enough pred to manage the inflammation, the CRP will be low. If you get to even slightly too low a dose, there will be a bit of unmanaged inflammation left over each day - it will build up over time, in the same way as a dripping tap will fill a bucket if left long enough. At some point it will overflow - and cause symptoms. You cannot be sure the PMR has burned out until you get to zero pred for about 6 months - it can take that long for low level disease activity to build up enough to feel, At this stage you have 2 different problems - is the PMR still there and at this stage it is almost certainly still active, and whether the adrenal function is returning. You haven't been on pred very long - it shouldn't be too much of a problem, but you never know.

[sdowney717]

One thing I have been trying is pulling that middle finger under tension to try to pull the joint apart. I have noticed I got a few more degrees of motion after that, not much but an improvement. I also have been squeezing it hard down by the knuckle on the bone and I felt a lot of deep pain against the proximal bone there but after some time that pain went away. So maybe related to fluid pressure building up in the tissues around joints of the finger. One good thing is after all that, I can sleep better, it used to burn like acid and I would have to get up and shake it off every hour or so. The top would burn, the bottom like cold numbing pain.

[sdowney717]

I have a pretty high pain tolerance having been thru major 3rd degree leg burns was the worst pain I ever had. The PMR pain was also terrible, not nearly the same level. I am used to suffering, so I have learned how to cope. My current pains are but a light affliction compared to my past, but it does wear on me. I don't think I can cope as well with chronic high pain levels if there is no hope of getting better. I don't feel my burns anymore, but I did for years after, the skin shrinks tight and every step was gut wrenching till the scars got better, Both legs all the way to the backside. Then skin grafts off my right thigh, just like another burn itself. This right leg all the way down to mid foot lost most of the skin.

burned legs