Flare or Adrenal Crisis

[Belfastman]

During the Christmas period I had a series of very stressful situations , including transatlantic travel.

Upon returning I experienced extreme burning pain in my neck, arms, shoulders and groin. I could barely get out of bed. It was the same pain I experienced when I was first diagnosed with PMR 2 1/2 years ago. The pain had been creeping up in the morning but I ignored it.

I was on 5 mg of pred and assumed it was a flare so increased to 10 mg for a week, with the intent of dropping to 6 mg . I had a scheduled appt with the rheumatologist at the end of the week. He commented that it it could have been an adrenal crisis . He was insistent I now reduce by 1 mg every two weeks until I return to 5 mg. not drop down to 6 and have a blood test in 4 weeks.

He said I should have called mediated so he could have arranged a test for adrenals but now that’s not reliable because I’m on 10 mg.

My question is should I slowly taper again or drop to 6 mg as given in flare advise.

I have also begun resting more - difficult when supporting a 99 year old Mum .

[DorsetLady PMRGCAuk volunteer]

It “could ” have been adrenals, but as the symptoms were similar to pre diagnosis -I’d plump for a flare…

If you follow his advice-it may well help adrenals -and to be honest 10 weeks to get back to 5mg is no great shakes in the great scheme of things. Plus as you are a carer you probably need all the help you can get.

If you go against his advice, he may not be so helpful in future…

[Belfastman in reply to DorsetLady]

Thank you for getting back so quickly. Yes I think it’s best I do as he suggested. 🦋

[SnazzyD]

I remember getting general fluey aches with adrenal insufficiency but specifically located extreme pain, no. I had GCA so no PMR to complicate the picture. I’d like to know what their basis is for them deciding it isn’t a flare.

[Belfastman in reply to SnazzyD]

The rheumatologist said without the blood test related to adrenal functioning he really couldn’t tell. So if I experience these symptoms again when I get to 5 mg I need to immediately get in touch .

He also questioned whether it was osteoarthritis but I insisted I know the difference and this was exactly like the pain I experienced 2 1/2 years ago . It definitely not the same as the aches I feel in my finger joints due to arthritis.

[PMRpro Ambassador in reply to Belfastman]

Not sure what makes him think the blood test would be any more relevant at 5mg - nor why what you describe was any more likely to be adrenal than a flare. Especially since you actually say that it "had been creeping up". Lower the dose slowly - because it really does sound to me as if the 5mg was very slightly too low (whatever he thinks) and you probably need very slightly more.

[Belfastman in reply to PMRpro]

Thank you again for the good advice. 😊

[SnazzyD in reply to Belfastman]

It just sounds like they want it to be not PMR rather thinking that there is a good case for the alternatives.

[sidra1968]

Well, for me- a plane ride flares me almost every time..those small seats and being in one, somewhat unnatural position for hours. I take extra Pred for traveling now.

[HelenDaisy in reply to sidra1968]

That’s interesting. I’m flying to Sri Lanka soon and I’m on 3 mg.

[Belfastman in reply to HelenDaisy]

Hope you enjoy your holiday. I was there over 45 years ago and loved it!