Is musculosketetal condition associated with PMR

[PatB1948]

I have not written on the form for a while but would like your thoughts on the following:

On Sunday night and all day Monday I had chest pain especially when breathing in, and both shoulders and upper back were sore. It was still very painful on Tuesday so I phoned GP and was told as it was chest pains, go straight to A & E which I did. They did the usual obs and said my temperature was up and I was hot and clammy, also my breathing was laboured. The did blood tests including Troponin levels they all came back fine apart from Troponin which was slightly up at 55.6 so they would have to do another one 3 hours later. They thought I might have an infection somewhere in my body. I got admitted to the ward they did another Troponin at the appropriate time and that came back within limits. The consultant said it was not my heart as all the tests (including ECG, blood pressure, Troponin and other bloods) were okay. I also suffer from AF and he said that was well controlled. I mentioned PMR and they did not think it was that. In the end they said it is a musculosketetal condition causing the pain when breathing in. They said to take painkillers, Paracetamol and Cocodamol. They said PPI’s would be better but I cannot take take them because of stomach problems.

What I wanted to ask is, has anyone had this whilst on Pred. I have just reduced from 9.5mg to 9mg.

so not sure if this has anything to do with it. I got home from hospital yesterday and I am still having some pain whilst breathing in, from chest out to right shoulder. Any thought?

Thank you, sorry for such a long post.

Pat

[PMRpro Ambassador]

Well, PMR IS a musculoskeletal condition. What is often found alongside PMR is myofascial pain syndrome - the inflammatory substances form trigger points in the larger muscles and can be felt as hard knots of muscle fibres. They tend to irritate the surrounding area of the muscles and the muscles become hard and tight and they and any nearby irritated nerves cause pain, which may be referred to the area of the body the nerve supplies. Spasmed/tight muscles can cause a lot of pain and that MAY be the shoulder and neck problem. Could the chest pain be costochondritis - where is the chest pain?

They probably didn't say PPIs would be better, they probably said NSAIDs - non-steroidal antiinflammatory drugs - but they tend to be associated with stomach problems - for which you would take a PPI in fact for stomach protection.

Is that what you wanted to know? Are you still on pred for PMR?

[PatB1948 in reply to PMRpro]

Thank you for replying so quickly. I didn’t know that PMR was a musculosketetal condition although I have seen you referring to myofascial pain. It is very interesting to hear of the effects of these conditions. They did not mention costochondrits which I assume is relates to the intercostal muscles. The chest pain was in the middle of my chest and my right breast and shoulder.

Yes you’re right about the PPI’s and NSAID’s, I never remember which are which. I am on Pantoprazole and Famotodine, Peptac and Lacutulose. I recently had a GI bleed caused by Naproxen prescribed by a rheumatologist, he said he did not think I had PMR and the rear neck pain was coming from my C spine so pain killers would be better than steroids for this. At the time, I did not realise that Naproxen is an anti inflammatory drug. GP said a Gastropathy is recommended after a GI bleed. I waited 10 weeks for the appointment and still awaiting the results.

I have been reducing the Pred from 15mg after a flare a year ago and now on 9mg. Since being home from hospital yesterday, I have increased it to 14mg under the sick day rules. I am feeling much better today.

All the information you have given me is very enlightening and helpful. Thank you very much.

Pat

[PMRpro Ambassador in reply to PatB1948]

Costochondritis is often central - around the sternum. And the pain can radiate to the arms and shoulders.

mayoclinic.org/diseases-con...

I think your rheumy could do with a refresher course in medication interactions!!! Glad he isn't mine ...

[PatB1948 in reply to PMRpro]

It certainly sounds like it is costochondritis but it seem to affect both my right and left arms and shoulders. The Mayo Clinic article was very good but I think I’ll have to stick to Paracetamol and Cocodamol (not together of course) as Amitriptyline made me feel tired and confused and the anti inflammatories would only upset my stomach again. Do you think that upping the Pred by 5mg will be beneficial or should I not bother carrying on with the temporary increase.

Thank you for all your advice.

Pat

[PMRpro Ambassador in reply to PatB1948]

I suspect there is a mix of costochondritis causing referred pain but possibly also a flare of the PMR - you have just reduced the dose you say, even that 1/2mg is enough to let the inflammation out of the bag.

The only way to find out if more pred helps is to try it - and this isn't a permanent increase of 5mg, if you use the flare protocol it will be 14mg for as long as it takes to get rid of the shoulder, often only a week, If it is gone, great and you say you are already better so obviously it is beneficial. I wouldn't go back to below 10mg. Make sure you are stable at 10mg and then start a very slow taper again.

[PatB1948 in reply to PMRpro]

Thanks again, I will do the 14mg Pred for a few more days and if okay, I shall drop to 10mg for a few weeks, then do slow taper again. I am feeling much better again today, chest pain when breathing in is not so bad and shoulder etc just a little bit sore. I feel really tired though.

Pat

[PMRpro Ambassador in reply to PatB1948]

The extra pred will deal with a lot of the inflammation but some will persist for a while. Good luck with dropping back to the lower dose - but do be wary in case it persists.

[PatB1948 in reply to PMRpro]

I’ll let you know how I get on and thanks again, you are such a fountain of knowledge. We are so lucky to have you as an ambassador.

[RosyPollyandMe in reply to PMRpro]

Really interesting info re Costochondritis. At the risk of sounding like a hypochondriac 🙄 I have the pain as described in the weblink you sent. A pain which I thought was caused by my acid reflux and I have noticed a swelling down my sternum for some months.

You guys are so helpful in sharing your knowledge. Thank you all 🙂

[PMRpro Ambassador in reply to RosyPollyandMe]

It really isn't unusual to find it alongside PMR so no - not a hypochondriac!!!

[RosyPollyandMe in reply to PMRpro]

Phew 😅