Prednisolone and breathlessness

[Buchanan16]

Hi everyone i hope you all had a lovely and hopefully pain free Christmas.M y 86 year old mums GCA journey so far has had a few challenges along the way since starting early March and after our last rheumy visit she has reluctantly let us continue following DL slow taper from 13mg to 12mg and my mum is currently looking great and feeling quite well.The only concern we have is she is quite breathless when doing anything. This started initially back in August and her bloods showed she was deficient in vitamin b12 and started on course of injections. It did seem to improve her breathlessness and definitely helped her light headedness for a bit. However She had her last injection early November and it doesnt seem to have lasted as long this time.

They did say she could get her next one earlier if she felt symptoms were coming back sooner but im just wondering if we should mayb make an app to get full bloods done incase anything else going on.

I know prednisolone can also cause breathlessness so it could mayb be that and im mayb over reacting as usual.

Other than this and very slight increase in her CRP and ESR( altho they are still within healthy range according to dr) she is best she has been in months so i dont want to worry her but feel we should mayb get it checked out.

Before being diagnosed with GCA she was put on iron as she was deficient in folic acid which also caused breathlessness but it cleared up as soon as she was put on course of iron tablets.

Does anyone know if its possible to be deficient in B12 and folic acid at same time?

This forum has been like therapy for me and you have no idea how much it helps for me to just get out whatever is going on in my head sometimes.

So thank you all for letting me rant and for all your wonderful advice and guidance over the past 9 months esp DL and PMRpro it has been invaluable to me and i honestly dont know what i would have done without it.

Thanks again.

[PMRpro Ambassador]

practicenursing.com/content...

may be helpful - yes, they can occur together and the folate deficiency should be corrected after B12 has been measured.

As for the rising markers - the range is not a "healthy range", it is the range of levels found in a large population of subjects, not a range that is acceptable in one person. If she has had a lower level, that is what they should be aiming to maintain and if the level is rising it should be checked at intervals to see if there is a trend. If there is - it could well be the pred isn't enough to control the inflammation.

[Buchanan16 in reply to PMRpro]

Thank you PMRpro for your prompt reply as usual. Ive had a read over the link you sent so thank you for that.Her CRP went down to 3 then 1 and stayed there for months before rising to 13 when she had a chest infection. Once that cleared up it dropped back to 8 then 2 then 4 and is slowly rising again and now at 8. I realise thats low for majority of people but when my mums been mostly at 1-3 i get concerned.

Thd rheumatologist dismissed my concerns on my visit and even our wonderful gp says as long as its below 10 theres nothing to be concerned about.

I get that and mayb im just being over cautious but i like to keep an eye on it and the fact its slowly increasing again and my mums a bit breathless im just worried theres mayb something else going on..Not necessarily GCA related but something working on her.

Anyway i will keep an eye on things and if theres no improvement or it continues to rise ile ask for further investigation.

Thanks again.

[PMRpro Ambassador in reply to Buchanan16]

It never ceases to amaze me how little they understand of normal ranges and how they are established! You are right to note the rising trend - the high level during the chest infection is to be expected and those low single figure levels are "HER normal". It is rising - and that is a warning to them that SOMETHING is going on. Acute infections result in an acute rise - this creeping up is due to an underlying chronic cause.

[Buchanan16 in reply to PMRpro]

Those are my thoughts exactly that theres something going on. She is due her bloods again just after New Year and if there is any further rise i will be making an appointment at the doctor and asking him to investigate further.I will keep you updated and thank you.

[Karenjaninaz]

I was talking to my endocrinologist my last visit and I discussed with her that certain vitamins are not absorbed while taking prednisone. One of them is vitamin D. I am taking 5000 international units and she said that’s fine. I am also taking a multivitamin with food.

[Buchanan16 in reply to Karenjaninaz]

My mum takes vitamin D and calcium supplements which were prescribed to her as soon as she started pred.

[PMRpro Ambassador in reply to Buchanan16]

Mmm - but HOW MUCH? The supplements are only 800 IU per day in total. I take 4000 IU, Karen takes even more.