Steroid injection in foot

[LMali]

I wonder if anyone else has had this experience? I have had PMR for 4 years and struggling to get below 5 mg. I have had a few minor flares just this year so regularly wake up with aching shoulders and arms. In February I had a steroid injection for my right foot which is really painful (injury/arthritis). It worked well, but had an unexpected positive effect on my whole body which I put down to the steroid in the foot flooding my body and boosting the daily Pred dose. Well the pain in foot came back so I had another injection yesterday. Same thing has happened - I woke this morning and before even taking my daily Pred, my shoulders were COMPLETELY pain free!!! I was swinging my arms around all over the place!! Ah, the joys of a massive dose of steroids!!! I have, incidentally, been referred by GP to a rheumatologist for the first time, as it is over 4 years since my initial diagnosis. I am quite looking forward to that although trepidatious that they will make me stop taking Pred!

[DorsetLady PMRGCAuk volunteer]

Many have found an additional shot of steroids helps- but only temporarily…

If you had a few minor flares recently -what have you done about them? Sounds as if you are just tad too low on Pred - is that why you are being referred to Rheumy?

They may well want to introduce MTX or similar if they think you re struggling at current dose- so be prepared for that…

[LMali in reply to DorsetLady]

I followed the flare protocol, increased by 5 for a week (which worked) then back down the the dose at which I thought I was okay (5) but still getting achey shoulders. Not agony but clearly not gone. I appreciate now that PMR is not the 2 year burn out suggested by the GP at my first diagnosis! I'm going to make the most of this boost!!

[DorsetLady PMRGCAuk volunteer in reply to LMali]

I'm going to make the most of this boost!!

Hope you mean by feeling pain free - and not by going mad and doing chores you have avoided over the last few months! …🤣😂

Once the injection has worn off, and if aches return maybe try a small increase-6mg?

[LMali in reply to DorsetLady]

Yes, I think I will go up to 6 mg. Makes sense - as PMRpro says, there is that little residue at 5 mg that builds up and never goes away. Hopefully 6 will be better. I'm not going mad with chores but pain free = more energy = good mood = do little things that without realising it, I have been just putting off like flushing out my fountain pen, processing a colander of tomatoes and a giant courgette that have been sitting on the side for days, sorting out all my recipe sheets and reminding myself which ones would be nice to make with current veg in season. All good stuff! I am following foot doctor's orders to take it easy physically for a couple of days. I think that is to let the steroids and lubricant soak in to the foot?! She didn't say that - that is what I am visualising!

[PMRpro Ambassador in reply to LMali]

"I appreciate now that PMR is not the 2 year burn out suggested by the GP at my first diagnosis!"

Certainly isn't - if only!!!!

[Bcol]

Nothing specific to add other than to agree with DL, to take care that the relief from the pain doesn't encourage you to do all the things you were sensibly avoiding before. Hope all continues well.

[PMRpro Ambassador]

Really does sound as if your pred dose is marginally too low. If there is any left-over inflammation each day that hasn't been managed by the pred, then that residue will build up slowly over time, just as a dripping tap will eventually fill a bucket and overflow. There is no virtue trying to manage on a slightly too low dose of pred - it will always catch you out.

The additional shot of pred is wiping up that overflow - until the level builds up again. It is quite common for someone to be diagnosed with PMR after an injection for something else resulted in all their other aches and pain disappearing - obviously due to inflammation since they responded to pred, and a bit of investigation confirmed that.

[piglette]

How fantastic to get relief without expecting it.