PMR or PsA or both

[Seal49]

I'm on prednisone since last April and have managed to get down from 35 to 10 mg with a few minor flares. My Rheumatologist thinks it could be PMR or PsA or both. Can't get a definite answer. It started overnight after a fall I had. Now I wake up really achy all over and after about an hour feel fine for 75, ha, ha. I'm only on prednisone 10mg. Any opinions would be a appreciated. Thx

[PMRpro Ambassador]

I'm assuming by "last April" you mean April '23 judging by your previous posts.

A fall is a typical trigger for a PMR flare, I suspect because it wakes up any myofascial pain problems and it all shoots off. Why does the rheumy think it is PsA - do you have a history of psoriasis , even in the family? It seems a common alternative from PMR sceptics and I really don't get why.

After 15 months many rheumies would expect you to be lower - we don't, it takes half of patients 15 months to get down to 5mg, usually from a lower dose than 30mg, so half take longer! But I suspect that you are about the limit for tapering at the moment if you are starting to feel it in the mornings again. 10mg is enough but is only just lasting the 24 hours.

Is there anything particular you would like to hear from us?

[Seal49 in reply to PMRpro]

I have a history of psoriasis. Usually never anywhere but on knees and elbows. The last dermatologist I saw before my fall had me using clobetisal cream. After I used a few weeks I had a bad hallucination and nightmare. This when I flipped myself out of bed and hit my side and neck bad. Sounds crazy, but then I read that clobetisal cream can do this and not to use more than 2 weeks. I felt ok and went back to bed. When I woke up I couldn't even move and had my wife get me up and to the doctors. He started me on prednisone.

[PMRpro Ambassador in reply to Seal49]

And it worked?

[AtopicGuy in reply to Seal49]

One of the weirdest facts in medicine is that sudden-onset confusion in us oldies is often caused by... wait for it... a urinary infection! Even when we feel no symptoms of the germs! The reason is not well understood, but it may be that our immune system activates to fight the infection, and that throws other things out of balance. It is very unlikely a few weeks' clobetasol skin cream caused the hallucination, nightmare and fall. Hopefully, your immune system has killed-off the germs, and the prednisone will calm down your overactive immune system.

[Seal49]

It was one of those like 5 day packs starting high and down before stopping. It worked for a few days only. That's when I saw a Rheumatologist. Does the way it started sound like PMR or PsA?

[PMRpro Ambassador in reply to Seal49]

Probably typical of PMR - especially the response to a short taper, symptoms easing and then back almost immediately, But it is possible a polymyalgic presentation of PsA would do the same and you have the history of psoriasis, though they try to pin it on anyone whether they've had it or not! They seem to think it a more worthy diagnosis than PMR for some reason. It really isn't possible to say - and of course, you can have both if you consider autoimmune disease as individual disorders. I have a different view - you probably have Seal49 syndrome and maybe there are a very few with the same characteristics, but it is just a subdivision of a wide spectrum. All they can do is manage symptoms anyway.

[Seal49 in reply to PMRpro]

Thank you for your input. I feel lucky to still be living a close to normal life except for the first few hours. I know it could be alot worse.

[PMRpro Ambassador in reply to Seal49]

You can play around with the dosing to get a better morning effect. Taking pred at 2-3am will improve mornings amazingly - the inflammatory substances are released about 4-4.30am. If the antiinflammatory effect of pred doesn't last a full 24 hours, they get into the body and start working to make inflammation which causes the syptoms to be worse in the morning. Taking prednisone at 2am, prednisolone at 3am, means it is there at 4am and the inflammation never starts so mornings are better.

If you don't want to go to the bother of the nighttime dose, you can take about 2/3 of your daily in the morning with breakfast and the rest later, later enough so that the effect lasts overnight until the next dose is due. Lunchtime is often late enough and it is out of your system by bedtime for you to be able to sleep well. It really can make a big difference.

I take a form of pred that you take before bed and it releases as 2am - brilliant!!! But not available in the UK

[EngineerMatthew]

sorry to hear that. My Rheumy took my off prednisone completely due to complications. Had to quit work and now use cannabis to entirely treat my illness with zero healthcare or income. Not what you would expect from a senior electrical design engineer huh?

[DorsetLady PMRGCAuk volunteer in reply to EngineerMatthew]

Needs must when the devil drives and all that.

Sorry to hear of your situation.