meniscus pain or PMR?

[Mfaepink1973]

I’m waiting for an operation on torn meniscus which MRI confirmed. The pain in my knees has got a lot worse over the last few months and a week ago it was almost unbearable. I started a slow taper from 5mg to 4.5 mg prednisolone last week and suddenly wondered if the knee pain might be more PMR than torn cartilage so at 2.30 this morning I took 10 mg and my knees are much less painful this morning. Should I treat this as a flare and stay at 10mg for another 4 days then drop back to 5.5mg? or do you think the higher doses of pred were masking the torn meniscus pain and that I should continue tapering to 4.5mg. I don’t have PMR pain in my shoulders or hips now.

[PMRpro Ambassador]

If it is BOTH knees and only one has a meniscus problem, then it could well be PMR starting up there. Difficult to say though.

[Mfaepink1973 in reply to PMRpro]

Thanks PMRpro. Both knees have meniscus tears and I’m due to have the left one repaired first as it is marginally worse.

[PMRpro Ambassador in reply to Mfaepink1973]

Ah, right. Sounds as if the pred has been masking the meniscus pain, Pred can be a good painkiller when inflammation is at the root of the pain. I certainly wouldn't be tapering any further until it is done.

[Mfaepink1973 in reply to PMRpro]

Thanks, I’ll take 10mg for a couple more days then drop to 5mg and monitor. Hopefully I’ll have the op soon x

[alan222]

I read your post with interest. I have been on a reducing dose of Prednisolone for my Polymylagia Rheumatica and currently talking 4 mg a day. Previously I was taking 4.5 mg a day. I have reoccuring PMR for the last 5 years. Over the last couple of weeks I have been experiencing knee pain, sharp and sensitive to touch. I thought that I had perhaps damaged the cartlidge. Similarly I don't have any pain in my shoulders or hips. I can't really provide any answers but I am going to query this with my consultant. Thank you for alerting me to this

[Mfaepink1973 in reply to alan222]

Thanks Alan222. My torn cartilage is not painful to touch, just used to hurt when walking especially on steep slopes up or down but lately have been sore and throbbing all the time which is why I wondered if the PMR had set up residence in my knees! I hope you get your knee pain resolved, good luck

[Pjso]

Each time I reduced my steroid dose I had a lot of pain in various parts of my body. The first time this happened I thought that it was my PMR returning. However I learnt that weaning myself off Prednisolone was/is hard and that I needed and had the support of my GP to reassure me that what I was feeling was Prednisolone withdrawal symptoms. All my blood test were negative for inflammation markers. I have been off steroids since February 2024 and I am still free of PMR symptoms. When I was worried about anything I had a telephone appointment with my GP to discuss my fears.

[Mfaepink1973 in reply to Pjso]

Thanks

[Mfaepink1973]

Thanks Freya32 but I don’t want to be using steroids as a general pain killer, just not sure if the torn cartilage pain had increased or if the PMR had gone from my shoulders and hips and moved to my knees. My GP is great and leaves me to taper as, when and how I see fit so no pressure from him to get off steroids

[DorsetLady PMRGCAuk volunteer in reply to Mfaepink1973]

Agree with your reply to Freya32 - and you shouldn’t be using Pred as a general pain killer that’s not what it’s meant for. Sometimes it is difficult to know what is PMR and what is other pain… that’s why we often suggest either upping Pred or introducing general painkiller for a short trial.

[Mfaepink1973 in reply to DorsetLady]

Thanks DorsetLady. I’ve taken 10mg pred the last 3 mornings (at 2am) and just have the meniscus pain now which is more localised than the pain I’ve had for the last few weeks. Do you think I should go back to 5mg and continue the taper to 4.5mg or go back to 5.5 or 6mg and stay there for a month to see if the knee pain increases again? My knee operation was delayed until I recovered from my bunion op and I see the consultant on 21st so hopefully will have the knee op soon 🤞

[DorsetLady PMRGCAuk volunteer in reply to Mfaepink1973]

Maybe take the 10mg for a few more days -and then down to 6mg. Then I’d inclined to stick there until you know what’s going on with knee op… and good luck when that happens.

[Mfaepink1973 in reply to DorsetLady]

Thanks DL I know I can rely on you for good advice. I’ll do as you suggest x

[PMRpro Ambassador in reply to Mfaepink1973]

What I would have said too!

[Johnnox]

Hi Mfaepink1973. When my PMR reached its undiagnosed high point, I found that any movement was crucially painful, and the fear of movement-associated pain invited the risk of falling. My GP was open to the possibility of PMR at the time and decided to put me on 25mg of Pred. as the usual pointer to the disease should substantial recovery from the restrictive pain be fully alleviated within a few days. That was about 10 years ago, and I have risen and fallen in dosages to as low as 1mg; currently on 3mg. My diagnostic is complicate by Parkinson's disease and myalgia encephalomyelitis. I have had 2 falls of consequence and now have 7 spinal crush fractures reporting their own exquisite pain levels due to the side effect of weakened bone structure leading to osteopenia. What fun! Although this is not a wonderful situation, I can only think that my situation would probably be much worse without the dreaded Pred. I think PMRpro would agree.

[PMRpro Ambassador in reply to Johnnox]

I certainly do! Just had my appointment with my wonder rheumy where I had to confess that despite being on Actemra, I cannot get under 7mg pred without the upper arm and shoulder muscles protesting and the elbow tendinitis returning, making doing ANYTHING involving hands and arms excruciating. So instead of reducing the pred now - I shall try going to 2-weekly Actemra injections which did work for a short time before. I am very blessed to have a set of doctors here in northern Italy for whom QOL is the prime concern. It is worth living here for as long as I can ...