Painful arthritic knees after flare

[icecreamlover50]

I was diagnosed with PMR in August 2024, initially prescribed Pred 10mg a fairly low dose due to osteoporosis. Tapered to 7.5mg by December then in early January 2025 caught a virus which turned into a chest infection and I had to be given antibiotics.

I had a flare after this and surgery put me back on 10mg again for approx 1 month, then last week another flare, I have now been prescribed 12.5mg (which I still have to begin, still taking 10mg) but I am now concerned about the effect this may effect on my knees which over the last few weeks have become very painful and I'm struggling to walk. Will the increased dose of Pred have increased damaging and painful effect on my knees? Prior to this, I was managing the arthritis with exercise and over the ibuprofen gel and paracetamol, which are having minimal effect now.

The surgery have advised that Pred can have this effect on knee arthritis and I am now worried that with the increased dose that my knees may get worse? The present flare has calmed down a little and not as bad as it was initially just issues with the knees.

I have been referred to rheumy but earliest appointment is next August/September and this is after the surgery have upscaled it 3 times.

I also have dental issues which the dentist is refusing to treat until he can communicate with the rheumatologist (who I have yet to see!).

I am 74, any advice please.

[DorsetLady PMRGCAuk volunteer]

hi and welcome,

Sorry to hear you are struggling, but I think your best option is to take the 12.5mg…remaining at 10mg if it is a flare is only going to let the PMR get further out of control.

As for knees, if the paracetamol and ibuprofen isn’t helping as much as normal, then are you sure it’s all down to osteoarthritis, PMR can affects knees as well. See picture. So a small increase in Pred might be sensible.

As you also have osteoporosis, the I’m guessing you are on a bisphosphonates like Alendronic Acid or infusions which is why dentist is querying treatment. But that really depends on what treatment is required…

Areas affected

[PMRpro Ambassador]

Hi and welcome!

PMR itself affects knees - according to one study, at least half of patients have knee involvement:

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

and I think that is a LOT more likely than that pred has worsened it. It is said that pred can speed the degeneration of the cartilage in osteoarthritis (OA) but many patients also find that pred relieves their OA pain.

As DL asks - are you on alendronic acid? That may be why the dentist is being iffy - there is a risk of the socket not healing well if you are on them but the risk is minimal and usually only found in oncology patients on infusions on a monthly basis - not the 1 a year rheumatology patients get. Pixix has a cautionary story about such reluctant dentists who allowed her dental problems to worsen because of refusing to extract the tooth causing the problem.

[icecreamlover50 in reply to PMRpro]

Thanks very much for the responses.

Yes, I have been on alendronic acid with bad side effects but have not yet had any infusion as most of the medications for OA have had side effects, I forget to mention that I also have diverticulitis which makes it difficult for me to tolerate lots of meds.

I don't know if my knee pain is caused by OA or PMR? How do I find out what is cause of knee pain?

There is a new medication out for OA but unfortunately it needs to be prescribed by a hospital consultant and GPs are not yet allowed to prescribe it.

What a dilemma , but you'll be pleased to know I have increased prednisolone to 12.5 from today,

[PMRpro Ambassador in reply to icecreamlover50]

If you have bad side effects with AA - just say no. There are alternatives so don't just put up with the cheapest if it doesn't suit you. What problems are you having?

You have told us nothing about yourself - even knowing the country makes a difference to what advice makes sense. I assume you are in the UK?

My advice would be to try the pred - it probably won't work overnight but if it is due to PMR it will reduce the pain after a while.

It may be worth asking for a referral to a rheumatologist as they have other medications available to them and methotrexate may help patients manage on a lower dose of pred for PMR as well as having been shown to also have a beneficial effect in OA.

However - if you are going to take pred at all, and since you already HAVE OA, you need to take the right dose to minimise the PMR effects. There is no point not taking enough - all you get are the adverse effects with no benefical effects to balance the scales.

[DorsetLady PMRGCAuk volunteer in reply to icecreamlover50]

If your OA is that bad why aren’t you being seen by a specialist who could authorise new medication? Or is that a silly question with the state of the NHS…

[icecreamlover50 in reply to DorsetLady]

I am female based in sunny (at the moment) Peterborough UK. Is there a group near me? I know there's one in Cambridge but I don't think I can cope with the drive at the moment with this unbelievable exhaustion, and parking is an issue as well as I can't walk far with the recent increased painful knee issue.

I was referred to rheumatology last August, and surgery have been chasing appt. for me with limited success, I have been told that I may be seen next August/September! I also call hospital on a regular basis as well, OA has got much worse over the last 3/4 weeks, possibly due to flare?

Thanks for your invaluable advice.

[DorsetLady PMRGCAuk volunteer in reply to icecreamlover50]

Sunny here as [Dorset] - much appreciated…as it seems to be been wet since I returned from NZ earlier this month.

Unfortunately there doesn’t seem to be any group closer to you at the moment… but there seems to be lots of new groups starting up.. so don’t despair.

You could always join the zoom one run by Penny on a monthly basis - or raise a new post and ask if anyone in your locality would like to meet for coffee… that’s how many start..

Next meeting is this Wed pm - see link - if you’re interested ..

pmrgca.org.uk/online-support/

I had dodgy OA knee when I had GCA [now replaced] so can’t really say how much it was affected by steroids other than the pain resurfaced as I got to lower doses of Pred.

The problem is sometimes is difficult to know if knee pain is down to PMR or OA.. sometimes it’s just a matter of seeing what helps - if Pred does it’s probably PMR, if painkillers help [whether tablets or topical gel] it’s more likely to OA.

[PMRpro Ambassador in reply to icecreamlover50]

"OA has got much worse over the last 3/4 weeks, possibly due to flare?" - I do wonder how much of your OA is really PMR. The first rheumy I saw about hand, foot and knee pain told me I had OA in the knee, she could feel it. Thirteen years later an x-ray showed NO sign of OA at all. And all those pains had gone after a few months of pred.

You have the pred - it is worth testing it out.

[Ginntonic in reply to PMRpro]

If it is of any help I take a rather sceptical view of diagnose of osteoporosis. I was diagnosed with osteopenia ( low level osteoporosis) about 15 years ago due to my phenytoin medication which obstructs uptake of vitamin D. Since then I have fallen walking in the mountains in Spain, fallen off a small bridge Inwas making and ripping a large lump out of the leg muscle and just recently fell flat on my face off a kerb 6 weeks ago and just month ago I fell over a cable 4” high

stretched across a path .

No broken bones & apart

from damaging my Achilles tendon & stitches when I fell off the bridge I am

fine.

I must just be more careful!!

[PMRpro Ambassador in reply to Ginntonic]

I have been talking about OA - osteoarthritis, nothing to do with osteoporosis.

However, I also was sceptical about osteoporosis and pred. My dexascans are still in an acceptable range after 13 years of pred - but a few weeks before the last one an x-ray had showed a spinal compression fracture. It isn't all about density - quality of bone is important too. And pred does result in changed trabecular structure which can collapse.

[piglette in reply to Ginntonic]

I would not be sceptical about the diagnosis of osteoporosis, if you are diagnosed with it you have it. Not like PMR when you are diagnosed you might or might not have it! I do agree the idea of pre osteoporosis with osteopenia and also pre diabetes I always think is something dreamt up by the drug companies to sell more drugs. I do agree it is a warning I suppose.