Diagnosed with polymyalgia. Have inflammation in hands. 15mg steroids raised to 20mg.
Took 20mg for 7days
To reduce to 15mg in 4 weeks.
If inflammation does not get better advised to have a steroid injection
Has anyone else had to have a steroid injection
I should imagine quite a few people on this board will have had steroid injections for various things. I have had a couple, though not for my hands. In my case they were rather a waste of time. They work well for some people though. An orthopaedic surgeon friend said it was very important to find the ‘sweet’ spot when you give them, so they are effective.
Is it getting better on 20mg?
On the 6th day of taking 20mg steroids was able to sleep so inflammation must have reduced. Just hoping the same tonight-hands still inflamed but at least I could get. To sleep
As piglette has said many will have - but probably for osteoarthritis, carpel tunnel syndrome, bursitis etc rather than the PMR itself..
as Charlie1boy has said 20mg to15mg is too big a drop… many struggle to manage a drop to 17.5mg. Think your doctor needs educating on PMR 😊
Hi
A drop of 5mg from 20mg is 25%, and the usual recommendation on here is not to decrease by more than 10%. The medics surely need to give the prednisolone a good chance to do its job of decreasing the inflammation first.
I developed pain in my wrists and hands with PMR, but for me, the pred did its job, and cleared it up.
Whatever, I just hope you manage to get it sorted.
I
I have been advised to reduce 1/2mg every four days from 20mg to 15mg which will take 30days. Do you think this is ok.
Not really- every 4 days [even though only 0.5mg] is much too quick… you won’t know if each reduction is enough before you reduce again….do that a few times and if you flare you won’t know what is your ‘good’ dose. Many find they need to be on each dose for at least 3 weeks each time, although 4 is much better.
As I said in previous reply, many struggle to reduce from 20mg to 15mg following the suggested taper in the guidelines which takes 3 weeks at each stage [20-17.5-10mg] so attempting it in a month is likely to be very difficult… no matter how it’s approached.
I would be so grateful if you can tell me how many weeks it would take to reduce 20 mg to 15mg so I can tell the rheumatologist. My maths is not very good
If you are on 20mg for 4 weeks… then [in line with most guidelines although not a guarantee] you may be able to drop to 17.5 for 3 or 4 weeks, and then if okay to 15mg for another 3 or 4weeks. That way would be about the same timeframe as you have been given… but at least you will be at 17.5mg for 3 weeks which is a more usual [and probably safer] way of doing things.
But as has been said, not everyone can do that, and end up have to go back to 20mg and then only reducing by 1mg per month.
What we are saying is that the plan you have been given is an unusual way of tapering… and not a proven way. It might work, but on the other hand it may not.. and you are left to pick up the pieces.
I am going to request I reduce 1mg every 4 weeks
I am sorry to bother you yet again but I am nervous making the request, so would appreciate knowing if you think this is reasonable
WE think it is reasonable but they may feel it is too slow. From 20 to 15 most people manage 2.5mg a month. They are keen to get you closer to 10mg/day as soon as possible if that can be done - some can, many can't.
Wondering if the rheumatologist refuses whether I should try and go privately
Probably not worth it - if he does think it is too slow, you could try and agree on 1/2mg every week.
Going privately you may find you see the same rheumy!! Or if you pick another one, it may be your same hospital, you may get the same response! If you drive a long way to one recommended by this forum you would probably get a different response. I don’t want to see you waste your money & get the same advice…it’s possible, I think!
You can ask, and as PMRpro says we think it’s reasonable- but whether your doctor will is another matter… but no harm in asking.
Thank you so much for your help
Many thank for advice
Well, I’m no medic, but this reduction means almost 1mg per week, which I would consider a bit fast. My philosophy was to stay at each new dose for about four weeks, and then only to reduce if I felt no PMR symptoms.
You may feel I was being ultra cautious, but it did work.
Good luck.
I AM a steroid injection!! Good luck i hope it works well for you if you get it done. They can be hit or miss and certainly worth trying and hopefully you will get some decent relief.
What sort of steroid injection? Into the local area of the pain or a deep intramuscular depot medrone injection?
Both can be used in PMR but if the diagnosis of PMR is correct, then more patience is probably better than an injection. It can take a few weeks for synovitis pain to go. PMR doesn't always respond in days, whatever they may think.
Is this your GP taking this approach - including the reduction from 20mg? It is nothing like any approach I have ever come across before and I suspect he may not know an awful lot about PMR.
Yes…I’ve had about 50 of them, maybe more. Some results excellent, some didn’t last as long as I would like! It depends on what you’re having them for…mine have been for osteo arthritis, bursitis, tendinitis, lots of different things! Just like having any injection, really.
I’ve had steroid injections in my wrists several times, first for carpal tunnel syndrome then for osteoarthritis. Sometimes they’ve been very effective and other times have made no difference. As piglette says it depends if they hit the “sweet spot” which is why an ultrasound guided injection is better.
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