Costochondritis with Prednisone?

Hi Bob I have exactly the same in my ribs when I sneeze or cough the pain is excruciating ,some times when I take a big breath in it absolutly kills me .ive had PMR for 2 years now and i have reduced PRED from 20 mg to 7 mg ,so yes I know exactly what you are going through x

Has your doctor arranged for an ECG, blood checks or X-ray to rule out other causes? If it is costochondritis you can have a steroid injection to help the pain if very bad. Applying heat to the area can help, also paracetomol may help. Avoid doing anything strenuous though, which you probably will anyway if you have PMR.

If you've been on PMR doses that isn't particularly high - with the 15mg I was started on it took months before the tendonitis/synovitis/bursitis problems I had improved significantly. When the trochanteric bursitis reappeared I was on Medrol - although I concede it didn't appear to do anything for the PMR even at 20mg whereas as soon as I was switched to Lodotra the PMR responded in the typical way at 15mg. But it took steroid injections to deal fully with the hip bursitis.

Cartilage does not have a blood supply and heals because of the white cells present in the joint fluid around it rather than those in blood - so it takes much longer. Oral pred enters the blood stream to be transported to the muscle cells - but nothing like as much gets into the synovial fluid. When a cortisone injection is used near to the most painful spot in bursitis then a concentrated amount of pred surrounds the area. In joint injuries it works best when put directly into the joint - but often the injection misses the optimum place which is why sometimes they work, sometimes they don't: the success rate is about 1 in 3. 

Is your doctor not willing to try a steroid injection? Particularly since it seems to be getting worse rather than better, costochondritis is said to clear up in a couple of months. The usual option is NSAIDs - but that's not advisable for us - and a steroid shot might do the trick. It'll be much the same as a broken rib - OUCH, OUCH and OUCH! 

I had pain in my ribs that was the referred pain from myofascial pain syndrome causing trigger points alongside the spine to irritate nerves - it never got to the sternum though.

 

Eileen my own GP is pants where PMR is concerned ,he hasn't got a clue ...... As formy RHUMY I have had him for 2 years he was really good ,any probs I had I could just ring him up .but last month when I went for my check up appointment with him ...the nurse said oh mr prince has retired so you will be seeing another consultant today ))))-: basically he said ,as they all do slowly reduce PRED ....oh and you will be in a little pain as you reduce x

Hi Bob, I am a newbie was just diagnosed in November with PMR and am on 20mg of pred.  Someone with more experience will get back to you.  The people here are second to none and give plenty of support, advice and information.  Hope you get sorted.

Pat

Hello Bob, I think on this subject you'll get plenty of replies!

i've had PMR since dec 2013. But prior to diagnosis I went through pretty much what the rest of PMR sufferer do, a general build up and increase of pain and stiffness to neck, shoulders, arms, hips and bum, knees, well I could go on and on. But about a week before my eventual rheumatologist appointment the pain and stiffness was at its most severe and at this time I also developed pain and tenderness around my whole rib cage on the rib just below my breast, the pain was worse just to the left of my sternum and I honestly thought I had something very wrong with my heart.

i had about a month prior to this been for a endoscopy and that revealed a sore in my stomach at the point were my osphogus (spelt wrong) meets my stomach.

like you when I was diagnosed I was prescribed preds and whilst still on 15mgs the pain in this area was still bothering me so I told my Dr and she prescribed omeprazole, believing that the sore in my stomach was being annoyed by the steriods, although I had the pain prior to steriods. Anyway, the pain cleared up nicely!

i been reducing my preds and got down to 9 mgs and I thought the pain was coming back again although very mildly, but following a flare up I again suffered from tenderness and pain around my rib cage, the one just under my left breast and to the left of my sternum. Even after upping my dose back up to 10 mgs the tenderness to my rib went away but this annoying pain remained. On Wednesday last week I went to my gp to speak with her about it. She gave me a full examination and blood tests but does not know what can be wrong with me, so she has booked me in for ultrasound told me to increase my omeprazole to 1 in morning and a further one in the evening. Tomorrow I go to see her to see for the blood results but funnily enough doubling my omeprazole has greatly improved the pain, but I'm still going to go for an ultrasound.

so to cut along story short, could you also have a problem with your stomach that perhaps a endoscopy rule out problems there.

it is also possible that PMR symtoms to include the rib cage and because this area of your body is effected by the PMR will react to (flare up) when preds are reduced although you say that the dose is still high.

these are just 2 possibilities, but I will say that the pain in this area was the most frightening as I believed it was my heart or heart valve.

before I went to the dr I looked up costochondritis thinking that my pain could be that. The Dr didn't say it was that but it could be I suppose. 

Good luck Bob (it seems funny writing that name when not in connection with my husband)!

christina

To all,

Thank you all so much for your comments.  

The "blood supply" issue seems very relavant, but so does the stomach issue -- although my stomach has never really given me any kind of problem.  I also like the idea of the steriod injection, although I understand that it's rather hit and miss.

Another thought I always have is stress-related.  It seems I do feel worse when the stress levels go up.  In fact, this whole stinkin thing started when stress levels peaked. I know, I know-- reduce the stress levels, right?  But sometimes that's like saying "stop breathing."

Thanks to all of you who have made me realize I am not alone in this.  This is an excellent forum.