My challenge is that around the same time i was diagnosed with Pmr i was experiencing mobility issues which resulted in a hip replacement followed by a year later by a knee replacement on the opposite leg which I am now 6 month post op . I am not sure if my fatigue on effort is normal after the joint surgery or if my Pmr is causing it. Have my ortho follow up so hopefully he will be able to advise.
Anybody else have similar experience?
hi, can you say what dose of pred you are on now as that will help a lot
You mentioned fatigue in your last post - when you also asked about a cough… but a KJ says if you say what dose you are on that would help.
If under 7 or 8mg it could well be due to your adrenals stuttering—so perhaps have read of this -
healthunlocked.com/pmrgcauk...
Plus both the infection and the surgery will have put a strain on them.
Cough has gone was given antibiotics although they thought it was viral . I am on Leflunomide 2omg daily . Thank you for your response
Fatigue is a common side effect of Leflunomide..,
Were you on pred to start with before switching to leflunomide?
Do you take other medications as well? Would you mind sharing what they are ?
Sometimes the combination of medications you require can add to your Fatigue and other symptoms for various reasons, it's not always just the Pred on its own , or lack of it.
How are you coping in the Leflunomide , and do you feel like it's controlling the PMR symptoms you were having ?
Working out that for yourself by keeping a little diary of your symptoms each day can help a great deal in sorting out what's going on.
My first thought, even without this extra information, is that, unfortunately, it is likely to be a combination of both of your conditions , and the effect of the body suffering stress from dealing with them and any medications each day which is adding to the Fatigue you have.
Unfortunately, you are on of those patients whose conditions and the symptoms that come with them is made more severe because you've been hit with two or three health problems that affect your joints and muscles at once.
All of the conditions affect how well or quickly you recover and well you feel in general , even if your treatment is appropriate.
It's much slower to recover from multiple conditions at once than it is to be able to concentrate all your time and energy on healing just one, especially as each condition affects your general body health overall and can cause a flare in the pain you have from the others .
The effect of multiple health conditions and the medications you quite often require to help manage them can also reduce your general level of fitness not just your mobility and exercise tolerance.
The jobs of recovery your body does can begin to reduce the amount of stored nutrients you have in your body and how well you absorb those nutrients , even if you have a good diet. Over time this begins to have an impact on energy, mobility , fatigue , pain , exercise tolerance and breathing and you start to build up lots of other niggling little symptoms as well.
Which is why it's worth requesting that your GP does a set of blood tests if you've been ill for sometime , or you have been , or are on certain medications like Steroids, PPIs , NSAIDs, Antacids, Recurrent antibiotics, and various other medications for more than six months , and, have these tests every 6-12 months whilst you are still receiving treatment. This is also recommended by NICE , which is something to remind a GP if they are reluctant, initially, to test you.
It helps to rule out many of the causes adding to your Fatigue, like Anaemias, low B12 or Folates, Vitamin D deficiency, mineral imbalances and dehydration.
The tests to request include Full Blood Test , Liver Function Test, Kidney Function Test ( electrolytes), Ferritin, Vitamin B12, Folate , Vitamin D and Magnesium.
If your vitamin B 12 or Folate is insufficient / Deficienct request a test for PA antibodies/ Intrinsic Factor before you start supplements , so that you know that this is the cause and rather than dietary absorption and know you will require supplements long term.
When you have the tests done request a copy , particularly if the GP states they are normal.
Often normal tests can still mean that you are in normal range but are still very low or borderline to having an insufficiency, and people begin to get symptoms earlier than others, especially if they are already coping with health problems.
If things are low it's better to start trying to improve levels before they get worse , particularly if you already suffer from things like Fatigue and Adrenal Insufficiency and still take several medications.
You can do this by increasing your fluid intake to the recommended daily amount even if you don't feel thirsty, especially at meals or during exercise.
Checking if you have enough foods including B vitamins , Iron , Vitamin C, D , A, E and soluble fibre in your current diet .
Improving your intake of lower nutrients by taking supplements that are absorbed in the mouth rather than in the stomach , like a sublingual tablet , spray or liposomal drops.
Get retested 6 months later if you had low borderline figures to ensure that what you are doing is working.
And also be patient with yourself while you are still being treated for PMR after operations, your body has been through a lot and us still coping so you often won't recover your activity and mobility as quickly from operations as you would without PMR or other things like OA .
Encourage yourself by being positive for whatever you manage to do each day , no matter how small, and try doing little amounts of physical activity through the day rather than one big walk or one long session of exercises when you feel exercise is too hard.
The "little and often" approach us easy to cope with , boosts your energy through the day , reduces pain flares and injuries and helps build up your strength and ability to keep increasing what you can do more successfully over time. Even just starting with a few minutes stroll or a few gentle stretches each hour makes a big impact on how well you begin to feel and reduces the effect Fatigue can have.
I recommend these tips to anyone with long term health issues , especially if those issues cause Fatigue and mixed problems with Pain.
Take care , Bee
Yes I have a similar story-I was diagnosed with PMR before Covid but already having hip problems, so I had a hip replacement just over 2 years ago, still taking prednisolone. My hip dislocated, but once fixed I gradually came off the pred. about 18 months ago.
I recently had a knee replacement in April, incredibly painful, but very gradually there are improvements but the last 3 weeks or so have seen the start up again of very painful muscles and tendons and stiffness, just like PMR, but all over, not just the one leg as I would expect after the op.
I did have blood tests some weeks ago, but don't know what to do now, whether to wait and see (which I probably will). My physio says it could be a flare-up, so I'll keep you informed!
Jean
PMR & Osteoarthritis in Knees
2mg pred fatigue, running on empty
PMR / Pred & fatigue
FATIGUE
Knee and hip replacement hampered by Covid lockdown then PMR was 
