Flare Strategy?

[Donna5658]

After having a flare 4 months ago and going from 4.5 mg to 10 for a week, then dropping back to 5.5 for 5 weeks, I have now tapered down to 5mg, where I have been for 10 weeks. My doctor seems fine with my staying at 5 for awhile longer. Three days ago and coinciding with much colder weather, I experienced a return of hip, buttock and shoulder pain after my daily 3 mile walk. I took the next day off, felt much better, and tried my walk again the next day. Same pain outcome. I am for obvious reasons skipping the walk today.

My question is, would it be okay to go up to 10mg for 3 days or so to sop up the excess inflammation and then drop back to 5mg? Along with cutting my walk time in half or not going at all until completely pain free? Or is it possible that just cutting my walks out for a week or more would allow my current 5mg to deal with the excess inflammation? The weather is supposed to continue colder than normal for the next week. I have noticed in the past that cold weather seems to exacerbate my PMR symptoms.

I am scheduled for a molar extraction in three weeks and if possible would like to keep my prednisone at a steady state of 5mg, which has controlled the pain well until this latest episode.

Any suggestions for how to approach this would be greatly appreciated.

PS One last question has occurred to me. I am having the oral surgery/extraction in exactly three weeks. At the moment the tooth I am having extracted has what is called a periodontal abscess or infection, but my immune system seems to be handling it pretty well and I have been able to stay off antibiotics. If I bump up to 10mg (from 5mg) for three days or perhaps a bit longer due to current flare, will that increase in dose make it more likely that the infection will worsen? Thanks!

[SheffieldJane]

I think your plan sounds sensible. I think I would do something very similar, especially as the symptoms are grumbling and as you say you’ve got significant dental work ahead and cold frosty weather is forecast. Make sure your dentist knows about your autoimmune disease and the Prednisalone. Mine gave me an adrenaline free anaesthetic and precautionary antibiotics. I would skip the walks unless we get a warm gloriously sunny day. I would also increase my dose to 10 mgs for a few days to head off another flare. Your ideal dose seems to be around 5.5mgs. Your doctor trusts you with good reason. Good luck!

[Donna5658 in reply to SheffieldJane]

Thanks for your speedy reply! I asked my oral surgeon about an adrenaline free an anaesthetic but he was reluctant to do this. I already have lots of extra systolic beats from the prednisone, so maybe I will ask him to reconsider. My heart usually goes berserk after local anaesthetic.

He has given me a really large dose of antibiotic for the day before and the week after the surgery (2000 mg daily of Keflex, divided into 500mg doses, 4 x per day). I have never taken that high a dose of antibiotic and am concerned about side-effects. Do you remember what they put you on and how high a daily dose?

Thanks again for your helpful reply. I think I will go ahead with the 10mg for three days and see how I do.

[PMRpro Ambassador in reply to Donna5658]

The dosage range for Keflex is 1-4g/day, 2000mg isn't that high. You can't compare the numbers between different antibiotics - the doses vary.

[SnazzyD]

Hello, if it seems to be the walking that triggers it and it gets better with rest, it might be worth trying rest first for a few days or a week until conditions improve.

[DorsetLady PMRGCAuk volunteer]

Think you might need longer than 3 days at 10mg. Usual advice is 7-10 days but okay to stay for 14 days… and as you have flared before, that might be more sensible . Then back to 5.5mg as 5mg sounds just a tad too low.

Some enlightened rheumies suggest not reducing during cold weather… it puts a strain on healthy bodies let alone those that aren’t.

And agree maybe give the walking a miss for a while until things have settled.

[Donna5658 in reply to DorsetLady]

Thank you so much for your helpful reply!

Is it likely that going up to 10mg for a week will cause the infection in my already infected (but not requiring antibiotics) tooth to get worse? Or to make me less likely to heal after the extraction? Thanks!

[DorsetLady PMRGCAuk volunteer in reply to Donna5658]

Not necessarily- I know lots of doctors/dentist worry about healing when on Pred. But I think it’s very much an individual thing, some people naturally heal quicker than others - and whilst Pred may make it slightly slower it’s not going to stop it altogether.

[Donna5658 in reply to DorsetLady]

Thanks yet again. At least I will hopefully have dropped back down to 5.5 two weeks before the extraction. And maybe the weather will be better by then…

[DorsetLady PMRGCAuk volunteer in reply to Donna5658]

Let’s hope so -on both counts… 😊

[PMRpro Ambassador]

I have low back problems that seem to vary from day to day - but a lot of walking or cold weather really stir it up. And both together can be murder!!!

Bear in mind too that cold weather and heart conditions of any sort don't mix well either.