Leg pain update and advice

[GreatGranny4]

Hi, I posted a few weeks ago about pain in my lower legs and wondering if it could be PMR related before I contacted my GP.

I had a face to face appointment with him and he said he thought it was caused by the osteoarthritis in my knees (which haven’t previously caused me any problems but I did have a hip replacement 10 years ago without any further problems) and it to mention to the physio I was seeing for my torn meniscus, she said the exercises would be the same for both.

We did a long haul flight to India on the 5th February, I was on 6mg as I didn’t taper on advice from the group, however by last Sunday I was so fed up of being in so much pain and hardly able to walk especially on uneven surfaces that I increased my dose to 10mg and within a few hours I had so much relief I wished I tried it earlier. The only problem I have now is that I need to drop back down but what dose do I go back to? We fly home on Friday 21st.

Sorry this is so long winded and I hope it makes sense, your advice would be very much appreciated, thank you.

[PMRpro Ambassador]

You are OK to stay at the 10mg for up to 14 days and can then drop straight back to what dose you choose. I certainly wouldn't drop back to 6mg, it probably wasn't enough to manage the PMR and it could well have been PMR causing the knee pain - been there, done that. The first rheumy I ever saw about hand, foot and knee pain claimed it was OA, she could "feel it in the knee". Thirteen years later here it was x-rayed because of a return of the same pain, which had finally disappeared when I was started on pred years ago and there was absolutely NO sign of OA. So I would go to 7.5mg, half a 5mg tablet, and see if the improvement is maintained.

The problem is going to be how your GP takes it - because he didn't think it was the PMR did he and he might come the "pred is a wonderful painkiller" line we hear a lot. It is - for inflammation. Not much else!

[GreatGranny4 in reply to PMRpro]

Thank you for getting back to me so quickly PMRpro, I think my GP will be okay when I tell him, he said it’s usually only larger muscles that are affected. I don’t doubt that there may be some OA in my knees as I haven’t been able to kneel for quite some time but it was just the type of pain I was experiencing that made me decide to go back to 10mg. I thought I could only increase for 7 days to be able to drop back down again.

I’m sure I’ll get my head round this at some point, in the meantime I’m very grateful to have you all to help and support me.

[PMRpro Ambassador in reply to GreatGranny4]

Oh what rubbish!!! Knee involvement is seen in most patients.

pubmed.ncbi.nlm.nih.gov/238...

And

bpac.org.nz/2023/pmr.aspx#:....

says "Pain or stiffness in distal joints can be present in approximately half of people with PMR; examine the hands, feet, knees and elbows for signs of joint inflammation."

No - you're fine, 2 weeks, And even if it was a bit longer, you could drop back in 2 steps.

[GreatGranny4 in reply to PMRpro]

Thank you PMRpro that’s so good to know and also very reassuring.

[Pixix]

I’m interested in your post as I have torn menisci in knee after a nasty fall. But I’m on crutches, barely able to stand the pain (tramadol, pain patches of Buphrenorphine & morphine!!) But are you saying that’s separate from the pain you had recently, as that pain was much improved by increasing pred? I’d love to know how long it took for your meniscus to heal sufficiently to go on holiday, please? We had one planned for January, then February, now thinking March, but may be April! Husband needs warmth & sun to treat his asthma (& also he had pneumonia twice last year)! Thanks for any info re the torn meniscus! I’ve had first physio…but he said to rest completely, use crutches for 2 weeks & stop doing all the exercises the hospital told me to do! Thanks & sorry to interrupt your holiday, S x

[GreatGranny4 in reply to Pixix]

Hi Pixix, it’s no trouble to answer you but I don’t know how much help I can be.

My problem started early February 2024, I was walking on level ground going to my car and my knee suddenly gave way. I didn’t really know what I could have done so just carried on thinking it would right itself but it didn’t so after a trip to the GP and an examination he came to the conclusion I had pulled my meniscus and gave me exercises to do. They didn’t help so I went back to him and he decided that as it wasn’t healing it must be a tear so I was then referred to the musculoskeletal team who I am now under for a six week course of physio. I don’t know where we will go after that as when I was assessed the physio said surgery probably wasn’t an option at my age, I’m 73. I haven’t finished the course yet as we have come away for a family wedding. After the flight I was in so much pain in both knees and legs I decided to up my dose of prednisolone just to see if helped and it did. It’s better than it’s been for weeks! I don’t know if that helps you at all but I hope you get your holiday soon.

[PMRpro Ambassador in reply to GreatGranny4]

The physio sounds a bit out of date: my daughter has meniscus problems and is being given PRP injections to encourage it to heal and she says the improvement is amazing. Available on the NHS.

sportshealthnorthwest.com/b...

[GreatGranny4 in reply to PMRpro]

That’s interesting PMRpro, I think I’ll bring that up at my next session when I’m home. I wonder if it’s anything to do with age as all the other people that I met at the physio session were of a similar age to me although they weren’t all there for exactly the same reason.

[PMRpro Ambassador in reply to GreatGranny4]

Who knows - but a dodgy knee can be improved without major surgery!!

[pegpowell in reply to GreatGranny4]

In 2023, I had left knee meniscus trim surgery at the age of 85 which was successful but I fell on my knee two months later which prolonged healing. Late 2024, a slight fall affected my knee enough to get a steroid shot. Whenever it starts to hurt, ice, rest, heat and walking daily temporarily cures it. Now, at age 86, am due for another steroid shot by my wonderful orthopedic surgeon who has replaced my other right knee, left hip, and helped avoid shoulder surgery. I have been in PMR remission for one year now. But now have to deal with clogged arteries, peripheral and carotid--never a dull moment.

[GreatGranny4 in reply to pegpowell]

Hello pegpowell , you’re certainly doing well after all your surgeries, I had a right hip replacement in 2015 and haven’t had any problems since then. I’ll see how my physio goes and if it doesn’t improve things I’ll talk to my GP about steroid injections. Unfortunately I’m no longer under an orthopaedic surgeon to ask his advice. I’m so pleased to hear you’re in remission from your PMR but there’s always something to deal with isn’t there?

[Pixix]

thanks, appreciate you taking the time, I really do! It’s interesting to see you are having six weeks of physio.,.I am on week two this coming week! That’s a whole year you’ve been suffering!! At the moment I can’t walk at all without crutches. I had a bad fall directly onto my knee & dislocated the kneecap (I have hypermobility & it happens)! I put the kneecap back in, but there’s obviously a soft tissue injury. I’m interested to see you’ve had no scan (or perhaps just didn’t mention it)?!?! I thought they would scan my knee to diagnose what I’ve injured, but I guess the physio can diagnose without one! But it seems as if your latest bout of trouble is PMR as the steroids help. I’m glad about that & hope your meniscus heals soon. Thanks for your help, S xx

[GreatGranny4 in reply to Pixix]

Hi again Pixix, I haven’t had a scan or X-ray, the doctor diagnosed it the first time by the movements I could do and where and when they caused pain. When I was referred to musculoskeletal I thought I would have a scan or something then but it turned out to be physiotherapists. The only thing I didn’t mention was that I was prescribed tramadol, at first I took four a day but now just take two.

I hope you soon get some relief from your injury, take care of yourself.

[PMRpro Ambassador in reply to GreatGranny4]

Yes - I was referred to MSK when I had back trouble. The guy turned out to be a physio with an extra bit of paper. He examined me and informed me I couldn't have a back problem as I could touch the floor with my hands, he couldn't! It's actually hamstrings that interfere more! But hey - never heard of hypermobility it seemed. I actually have a scoliosis which is part of the back pain problem, plus myofascial pain syndrome and PMR. SO MSK don't get a positive review from me!!

[GreatGranny4 in reply to PMRpro]

I can’t say I was overly impressed. When she made me the appointment for the class I told her I would be away for three Thursday’s so would it be better to wait until I was back, no was the reply. I turned up for the induction and after the physio said when you come next your programme will be here so just take it start the warm up so I said I was going away and wouldn’t be there for 3 weeks so she asked why I hadn’t waited for the appointment until I got back. Sometimes you just can’t win!!

[PMRpro Ambassador in reply to GreatGranny4]

Hope you reminded here SHE was the one who'd wanted you to start!

[GreatGranny4 in reply to PMRpro]

It was the physio who did the initial assessment who made the appointment and a different one who took the actual induction, it’s run by the NHS but in a gym not too far from where I live. Sadly I’m not a gym person but I’ll give it a go and see what happens!

[PMRpro Ambassador in reply to GreatGranny4]

Left hands, right hands, no hands ... I hope you enjoy it enough to do more - I hate the gym for machines but they did help and then you get to appreciate it more.

[GreatGranny4 in reply to PMRpro]

I have tried going to the gym, even joined one with my OH so we could go on the way home from work, it failed miserably when he bought me some personal trainer sessions for my birthday, the pt was 23 years old and just left the army, unfortunately he didn’t take into account our age difference and my ability, needless to say it wasn’t the best present I ever had and certainly put me off going to the gym!

[PMRpro Ambassador in reply to GreatGranny4]

I can imagine! When PMR started I had to leave the gym along the road from the house that had a couple of machines I was happy enough to use but had a few nice classes - PMR just stopped me doing the same things. I joined one with a pool and after an aquafit class I could go on and do a Pilates class with a lot of adaptation and later I started Iyengha yoga on the same basis - they were both amazing instructors. You have to find the thing that suits you,

[GreatGranny4 in reply to PMRpro]

I do like aquafit it’s just actual gyms that I have an aversion to…

[PMRpro Ambassador in reply to GreatGranny4]

Me too - but since I was going for the aquafit, I occasionally went into the gym too and there were one or two things I found beneficial. Aquafit is brilliant for us though - I think a mix is best. But PTs????? Nah ...

[GreatGranny4 in reply to PMRpro]

I couldn’t agree more more PMRpro!!!

[Pixix in reply to GreatGranny4]

Thanks, that’s great. Sounds the same in terms of treatment & diagnosis! Appreciate you coming back again…now run off (run??) and enjoy the rest of your stay! Many thanks, S x

[GreatGranny4 in reply to Pixix]

Oh to run, wouldn’t that be great??

It’s actually bedtime here so that’s where I’m off to now. xx

[Pixix in reply to GreatGranny4]

Thought you would enjoy that one!!!!! I’m in bed already, not a great day here! But there’s always tomorrow! S x

[AmberAliona]

I wouldn’t try to taper until you are home and rested from your long flight. I had similar after a trip to Australia last year.

[GreatGranny4 in reply to AmberAliona]

Thanks Amber Aliona, strangely enough I went to Australia last year to visit my daughter and I didn’t have any problems with my PMR, I just slipped an extra dose of prednisolone in during the flights. I did however manage to get cellulitis which wasn’t very pleasant! Maybe I just need to give up holidays!

[PMRpro Ambassador in reply to GreatGranny4]

"Maybe I just need to give up holidays!"

Perish the thought!!!! But holidays are different now aren't they? I never considered family visits as holidays - mainly because visiting my MIL with small children was a nightmare with all the glass ornaments and Royal Doulton ladies at low levels ...

[GreatGranny4 in reply to PMRpro]

We don’t really class Australia as a holiday as we try to do the same with the granddaughters and great grandchildren that we do at home with the ones there. I must confess I do have Royal Doulton Ladies but they are in a glass display cupboard too high for little fingers to reach.

[PMRpro Ambassador in reply to GreatGranny4]

MIL had them on the fireplace base!!! And little glass and pottery creatures on shelves over the radiators. With a 4 year old and a 1 year old I couldn't sit for a moment. I begged her to put them away but she thought they should learn not to touch ...

[GreatGranny4 in reply to PMRpro]

I definitely don’t do pottery creatures and sadly I think your MIL was wishful thinking, it’s far easier to move things out of the way and put them back when the little ones have gone.

[PMRpro Ambassador in reply to GreatGranny4]

My view entirely!!! Lot to be said for display cabinets!!