Tooth extraction and advice on increasing steroids and stopping methotrexate

[KASHMIRI1]

Good morning this is my first post so apologies if it's not ok. I have had GCA since 2020 and have managed to reduce steroids to 5.5 from the initial dose of 60mg. I am currently struggling big time at that level. On Monday l am due to have a molar extracted and wonder if l should increase pred on that day or earlier or not at all. And not take the meth which l had to stop for a while due to a skin infection? I have tried to contact my usual helpful rheumy but with no luck. Any advice would be gratefully received.

[PMRpro Ambassador]

Hi and welcome!

First - if you are struggling big time at that dose, is it GCA struggles or adrenal-type struggles?

By meth - I imagine you mean methotrexate? I would leave it until the socket has healed well.

I have never increased pred for dental work but I was probably at rather more than that. SInce you are skating on thin ice from the sound of it, it might be a good idea to take 10mg for the day and then go back to normal dose.

[KASHMIRI1 in reply to PMRpro]

Thank you for your reply. I will do increase for the day and not take the methotrexate until it's healed. I am not sure if l am having adrenal issues or GCA issues at the moment. I do have a headache though that's hovering around my occipital area and one temple this may also be stress related due to having had a very painful hip problem for over a year. I have only had physio treatment so far. I am considering private treatment at the local Lansdowne hospital as it's getting worse.

[PMRpro Ambassador in reply to KASHMIRI1]

If you have PMR and also trochanteric (hip) bursitis, then physio is unlikely to help much as the PMR "feeds" the bursitis as it can be part of PMR,

Have you any access to extracorporeal shock wave therapy via the local Lansdowne hospital? That really does help bursitis.

[KASHMIRI1 in reply to PMRpro]

I have only been diagnosed with GCA although l have a suspicion that l had PMR first to some extent my rheumatologist won't have that one though. I was given exercises for bursitis in July 2022 which helped. Since late November something changed which is gradually getting worse as l can now hardly walk to the bathroom. Not sure yet of the Lansdownes facilities. thank you for your time once again.

[PMRpro Ambassador in reply to KASHMIRI1]

Can't see why he would deny PMR - it is commonly a symptom of GCA and in our experience "pure" cranial GCA is relatively rare. What happened in Novemeber? DId you reach a particular dose?

[KASHMIRI1 in reply to PMRpro]

Thank you once again for your help. In November after months of physio exercises my hip problem seemed to get better. But my husband had a TIA and I had to go back to our business and picking up a lot of things that he did. My hip pain has just got worse since then and this morning I can hardly weight bare on it. Nearly tried to see my G.P. but thought the stress involved just wasnt worth it as I could access a pretty quick private appointment instead of waiting months for my N.H.S. one. After my tooth extraction and the week after a long awaited autism assessment ( 4 1/2 years ) My Rheumy has been very good but is rather certain of his himself I politely say. He said I didnt have enough pain etc to have P.M.R. If my hip gets worse I may have to venture to A and E. avoiding Doctors strikes next week for 4 days.

[PMRpro Ambassador in reply to KASHMIRI1]

"He said I didnt have enough pain etc to have P.M.R"

Plonker - your pain is specific to you and some people don't have excruciating pain, just all the time lower grade pain. You can have the stiffness without a lot of pain if you don't have much bursitis. They do have some strange ideas about PMR.

The quickest solution to hip bursitis is a steroid jab - but it may not be bursitis so an x-ray is worth seeking to rule out other things. An excellent alternative to steroid injections is a few sessions of extracorporeal shockwave therapy, 2 weeks apart. Some private physio practices offer them - no idea if the NHS does. Probably not as it is non-invasive and works ... It is the same technology as the lithotripsy used for kidney stones but adapted for soft tissue.

What happened in November was enough to make it all flare, If you cannot walk on the hip - really worth trying the ED even if just to access an x-ray.

[KASHMIRI1 in reply to PMRpro]

Thanks for your help and humour just great. He did arrange for me to have an xray but as usual said if you dont hear from me then theres no problem.!!!!!! same as for all my blood tests.

[DorsetLady PMRGCAuk volunteer in reply to KASHMIRI1]

as usual said if you dont hear from me then theres no problem.!!!!!! same as for all my blood tests.

That’s not good enough -you are entitled to know all results… good, bad or indifferent.

[KASHMIRI1 in reply to DorsetLady]

It would certainly be helpful especially as half my appointments are in Hampshire and half in Dorset. Plus grumpy GPS going on when they can't see results and complaining when l need to see orthopaedics now. The words were you have a rheumatologist. I know l think to myself but need to see orthopaedic people now. I didn't say anything.

[PMRpro Ambassador in reply to KASHMIRI1]

So what is the point of having different specialities? Or was it being suggested you are being greedy having more than one problem? Either way - very unprofessional.

[KASHMIRI1 in reply to PMRpro]

She upset me so much and stressed me out that it took two days to get back to reasonably normal

[KASHMIRI1 in reply to PMRpro]

She upset me so much and stressed me out that it took two days to get back to reasonably normal

[PMRpro Ambassador in reply to KASHMIRI1]

I would refuse to see her again - and if they don't comply with the request, make a proper complaint to the Practice Manager - as long as it isn't her!

[KASHMIRI1 in reply to PMRpro]

I would like to buy the surgery is very good and l fear being asked to leave.

[PMRpro Ambassador in reply to KASHMIRI1]

If it is usually very good - they will want to keep it that way and have happy patients. Don't start by saying you won't see her again, start by explaining that your last appointment upset you terribly and it took days to sort out your mental health over it. They should then ask what triggered that - and then you can explain.

[KASHMIRI1 in reply to PMRpro]

Thank you again how diplomatic that reply is.

[PMRpro Ambassador in reply to KASHMIRI1]

And I am not renowned for my diplomatic skills!!!You have to know how to get them on your side!

[KASHMIRI1 in reply to PMRpro]

You do indeed and is nice too have you on our side. Thank you for your help

[DorsetLady PMRGCAuk volunteer in reply to KASHMIRI1]

Half Hants/half Dorset doesn’t help - although both lovely counties… vested interest in both 😊

Are you on NHS App? That might help re results…

[KASHMIRI1 in reply to DorsetLady]

I have system online that shows me Hampshire stuff but not Dorset.

[DorsetLady PMRGCAuk volunteer in reply to KASHMIRI1]

I have same via my GP (Dorset) -but also have NHS App. Might be worth you looking to see if you get missing data -not sure exactly where info on NHS comes from -GP, hospital or both

[KASHMIRI1 in reply to DorsetLady]

Thank you l will have a look.

[KASHMIRI1 in reply to DorsetLady]

Thank you l will have a look.

[KASHMIRI1 in reply to PMRpro]

I have only been diagnosed with GCA although l have a suspicion that l had PMR first to some extent my rheumatologist won't have that one though. I was given exercises for bursitis in July 2022 which helped. Since late November something changed which is gradually getting worse as l can now hardly walk to the bathroom. Not sure yet of the Lansdownes facilities. thank you for your time once again.

[SheffieldJane]

My dentist knew about GCA and gave me anaesthetic without adrenaline, so it is worth telling yours. If I remember correctly I did take a bit extra for the inevitable shock of it all. I hope it all goes well. Those high doses are pretty difficult - may it pass quickly.

[KASHMIRI1 in reply to SheffieldJane]

Thank you very much my dentist does know my medical history so hopefully she will be on the ball. Pmr pro has suggested going up to 10mg for the day then dropping down again so l will do that.

[softekcom]

What a coincidence! I had my molar extracted on 22 Aug after about a week of pain and dialling around to get an NHS dentist. (I am no longer registered with an NHS dentist after having moved cities.) I too debated whether to increase my pred temporarily. I didn't - and i think I really suffered for it. I really should have - for whatever it's worth.

[KASHMIRI1]

Thank you so much for your information.