Jaw Discomfort

[Flinders61]

Advice needed.

Weaned down to 5.5mg Prednisolone over 21/2 years, had a recent flare possibly caused by surgery. Inflammatory markers elevated.

Instigated flare protocol for 10 days, reduced to 6.5mg but jaw discomfort returned within 5 days. Back on flare protocol for 5 days but jaw discomfort persists. Fatigue but no other problems. I think the discomfort/odd sensation might be worse after chatting with friends 🤷‍♀️.

Jaw discomfort was an initial symptom at diagnosis & was the last symptom to resolve.

I have a GP appointment tomorrow but I’m uncertain about what I want or need to happen. Grateful for any advice.

[DorsetLady PMRGCAuk volunteer]

Well as you’ve tried extra twice and it hasn’t helped, then either it’s GCA and the increase wasn’t enough… or it’s a TMJ disorder.

webmd.com/oral-health/tempo...

You say it seems worse after talking - how about eating?

If former scenerio, I’d go for TMJ, if latter then maybe GCA related..

[Flinders61 in reply to DorsetLady]

Thank you for such a quick response.

No worsening of symptoms when eating. Given that this jaw issue was present at diagnosis can it be attributed to PMR rather than a progression to GCA? What should I be requesting from my GP?

[PMRpro Ambassador in reply to Flinders61]

I had jaw claudication when chewing and also when singing - more intensive use of the muscles - but also had scalp pain and thigh claudication that went on over a couple of months and then it just disappeared. Baffled the Newcastle UK experts but more recently it is acknowledged that people do develope signs and symptoms of GCA along with PMR symptoms but then the GCA component seems to burn out and it reverts to more normal PMR.

Have you tried the Sydney chewing gum test?

anthonysammel.com.au/chewin....

sydney.edu.au/news-opinion/...

I think the delay in onset of jaw pain is a significant feature - other things might cause immediate pain, claudication is slightly delayed.

[Flinders61 in reply to PMRpro]

No significant worsening of symptoms when chewing. Given the dose of prednisolone I’m currently taking can GCA be diagnosed in any other way or can I further increase pred for a short time without having to wean at a slower pace.

[PMRpro Ambassador in reply to Flinders61]

Only if they have someone trained in the ultrasound technique - a biopsy is a bit drastic without distinct symptoms.

You could try the flare protocol - add 5mg for up to 14 days and drop back to the dose where you were last good. But if that didn't work in the past - is it likely to now?

[DorsetLady PMRGCAuk volunteer in reply to Flinders61]

Other than trying the flare protocol again as suggested -then no other way really…

[Flinders61 in reply to DorsetLady]

I’ll continue on increased dose & discuss with GP. Given it was an original symptom, the last to resolve & I have no other symptoms then I’m hoping it will settle 🤞

[Zebedee44]

I have reported jaw ache throughout my eight years with PMR and it’s a lot worse now, but always been dismissed by doctors and rheumatologist. I have managed to taper to 3mg but getting a lot of pain behind my ears when tired and when chewing. Strangely I also notice it when driving.

I saw a musculoskeletal doctor and he told me I don’t open my mouth straight up and down and gave me exercises. The dentist made me a mouth guard which I find myself chomping on at night and now my teeth are hurting too. It’s a mystery I haven’t managed to solve.

[Yorksman]

Unsure what the connection is between GCA and jaw discomfort.

Can you tell us more about it please.

[PMRpro Ambassador in reply to Yorksman]

GCA can lead to reduced blood supply to the jaw muscles. this tends to make them tire easily when chewing and they start to ache. The pain is called claudication - and the cause is the same as the calf pain people get when they have peripheral vascular disease, poor blood supply which isn;t enough when the muscles are being used.

[DorsetLady PMRGCAuk volunteer in reply to Yorksman]

PMRpro has explained, but this pictures shows the arteries in the head that can be affected

Head arteries

[DorsetLady PMRGCAuk volunteer in reply to DorsetLady]

And this - which shows in a lighter colour the ophthalmic artery because it much deeper] which is the one that affects sight.

More arteries

[Yorksman in reply to DorsetLady]

Thanks DL that's interesting. When I wake up in the morning I sometimes have a pain in my neck, then as soon as I lift my head up the pain goes up into the right hand side of my head. It's not a severe pain and soon goes, During the day it reoccurs if I bend down then straighten up or I lift my head up suddenly.

Any thoughts on this?

Unrelated to this and following my annual eye test my optician has referred me to the hospital ophthalmology department due to increased pressure in my right eye possibly due to poor drainage. I've searched HU but unable to find anything relevant.

[DorsetLady PMRGCAuk volunteer in reply to Yorksman]

Increase in eye pressures may be due to Pred, it’s one of the common side effects, but would expect it to affect both eyes, so ophthalmologist may be correct in that it is a drainage issue..was any advice/medication advised?

Maybe try a warm compress on eyes to open up drainage ducts - if it’s going to be used a lot maybe get something like this from that well known online retailer!

Re neck/head pain, as it goes so quickly could it be related to head position overnight, even the pillow? During the day, could be anything from change in blood pressure to something more serious - so probably would be sensible to discuss with doctors.

EyeBag etc

[Yorksman in reply to DorsetLady]

Many thanks DL. I've checked out the pillow height, firmness and sleeping position but makes no difference. Forgot to mention that it hurts my jaw when I yawn.

Your suggestion that it could be blood pressure related is perceptive as on my last medical review it appears that my BP is low.

The ophthalmologist has ruled out Glaucoma and recommends a laser treatment to open up the blocked drainage however on my next appointment I'll discuss the possibility of GCA just to be sure.

Will also follow up your suggestion re eye bags.

Again many thanks.

[DorsetLady PMRGCAuk volunteer in reply to Yorksman]

Jaw could be a TMJ/TMD issues - which may also transfer to give headache - couple of links to peruse at your leisure -

nhs.uk/conditions/temporoma...

webmd.com/oral-health/tempo...