Input appreciated on Pred reduction for diagnosis
Posted , 20 users are following.
I am looking for input to help me with a decision that I believe may be coming up. I have not been officially diagnosed yet, but I am educated and informed and believe strongly that I am dealing with PMR. I am an otherwise healthy and active 63 year old female who eats an anti-inflammatory diet that in many cases has eliminated signs of autoimmune disease in other patients/followers (The Plant Paradox). On December 1st (almost 5 months ago) I woke up with significant pain in my hips and thighs, different from anything I have ever experienced. I was a bit baffled, but thought I may have stressed my back at an exercise class. I do have a pretty ugly looking spine with bulging discs, but this is nothing new and I have managed it well and remained very active. Shortly after I developed excruciating pain in my shoulders and upper arms, to the point where I could barely lift my left arm (right was better but still sore) and even the weight of a blanket on it made me unable to move. It literally took me 15 minutes to figure out how to get out of bed. I was seeing a chiropractor who convinced me it was all related to my back. A few weeks into it he and the GP convinced me to try some high dose Ibuprofen, which did virtually nothing for me. Still thinking it was my back, I had an MRI and xray of my shoulders, nothing remarkable, the same messed up spine and mild OA in the shoulder, which would be totally expected in a 63 year old body. I was encouraged to do epidural steroids but by this time I was questioning whether this was my spine or something else, and I opted to do systemic oral steroids (30 mg Prednisone) instead. Guess what, a miracle happened and within 48 hours I was completely normal. I continued with the steroids, trying to reduce, and if the dose got too low my symptoms would reoccur, sometimes in different locations. In February I had the opportunity to talk to a neurologist acquaintance who stated unequivocally that I was describing an autoimmune condition and not my back. This made total sense to me as I was already reaching that conclusion myself. I made an appointment with a rheumatologist but it takes a while to get in. In the meantime I found information on PMR and I seem to check all of the boxes. I had not studied the tapering protocol, was just trying to get as low on the Prednisone as I could, but again every time I would drop too fast or get too low I would relapse. 10 days ago I had my appointment with the rheumatologist. She was very non-committal, as is expected, pulled a lot of blood but the fact that I was on Prednisone was obviously going to alter some results. All of that lab work came back normal - Rheumatoid factor, lyme disease, CRP and Sed rate, but I was on 15mg Pred/day. Rheumatologist advised me to get off the Prednisone completely for 2 weeks and then repeat the lab work "to get a diagnosis", and asked me to reduce Pred by 2.5mg every 3 days until off, then wait two weeks. I am skeptical, as every time I have reduced it I have flared, not a surprise if it's PMR. I am trying to be a cooperative patient and follow her instructions, but I am concerned. Already I am getting stiffer and more sore and have just dropped to 5mg. The idea of being off completely and barely able to function sounds counterproductive. It honestly doesn't sound smart to me to allow a giant flare to happen just to look at lab numbers. The last pain locations have been my wrists and knees, which I know are not typical, and shoulders flare as well until I jump on the pain. These areas were the last to cause problems. Previously it was thighs, hips and shoulders. Rheumatologist said that the fact that my wrists and knees were sore prior to a higher dose of Pred made PMR unlikely, but that is not what I am finding in my research. So my question is...do you think it's reasonable to allow a major flare just to look at some numbers? I have read that 20% of people with PMR do not have high sed rates and CPR. I don't particularly like this rheumatologist but am trying to be cooperative. If I flare like I am suspicious that I may, I am considering raising my Pred dose back up and waiting the several months it will take to get in with someone different. I hope I haven't rambled too much and sure appreciate the input. By the way, Prednisone supply is not a problem for me.
0 likes, 45 replies
phyllis48183 doni89057
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nick67069 doni89057
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don't envy you on the situation you are in. If you have been on high dose of pred for more then a month, I would guess that your adrenals are dormant and any fast reduction to zero may cause systemic crisis and lend you in emergency room at the hospital. There is no test for PMR and diagnosis is done by eliminating any other possible reason for increased CRP or SED rate. Now that you are on pred, those test should be in normal range ( that is the whole purpose of being on steroids). I can appreciate that you are trying to be cooperative, and perhaps the compromise is possible. If you were at 15mg and you lower your dose to ~10mg, by the time you have appointment, CRP and SED may be impacted and out of normal range. I said maybe, because 20% of PMR patients never have those raised. The time to get those blood tests were before you started steroids therapy. Have you done any blood test before you got on pred? If so, you could offer those results to rheumi.
I would not go to zero dose if it were me, it does not make sense.
Fizzyjam doni89057
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EileenH doni89057
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Many people have wrist and knee pain so that is immaterial. The trouble is, many doctors look at the guideline list of criteria - but they were developed for inclusion of patients in studies - and don't reflect the breadth of symptoms actually experienced by the entire population of patients. If they are fixated on that and ESR/CRP results and you happen to be one of the 20% who doesn't have raised levels - what will they say then? In some people the markers may be elevated before pred but don't rise again later - they are only a guide and symptoms always trump lab results.
As Dan has mentioned RS3PE sybrome goes for hands and knees too sometimes. And they need to rule out potential cancer causes of the symptoms we call PMR - but otherwise where's the problem?
carol_ann35477 doni89057
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Michdonn carol_ann35477
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Anhaga doni89057
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Coming completely off pred and risking adrenal crisis, not to mention a flare of the PMR which may be very difficult to get under control again seems at the very least to be irresponsible on the part of your rheumatologist. The time to do the differential testing without pred was before you started it. Even people who have been on pred for a week and experienced the miracle and then come off it to see whether the pain returns as part of the diagnostic protocol may have more trouble achieving the same level of pain relief once they are put back on pred for the duration. Whenever I read about this I cringe inside and count my lucky stars that my doctor accepted my rapid posisive response, plus the results of fairly comprehensive bloodwork, as sufficiently definitive of PMR and I just stayed on it. i stand to be corrected but I think I've heard of people having to reduce the dose of pred for further testing but they are at least allowed to stay at the minimum dose of 5 mg to avoid adrenal crisis.
ClaireJG Anhaga
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BettyE Anhaga
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" Whenever I read about this I cringe inside..."
I'm beginning to agree with whoever it was who said recently that we've had enough of specialists. So often we hear of hide- bound and ill-informed rheumatologists ( MS doesn't like my spelling ) on here.
I was one of the lucky ones, too, and so is my sister and both of us managed by our GPs.
Michdonn Anhaga
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Michdonn BettyE
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BettyE, I have two specialist a endocrinologist and a rheumatologist. One the endocrinologist is a detective and by far the best doctor I have had in my 80 years. It people, some continue to learn no matter the profession and some people, think that things don't change that we don't progress and they are wrong! ??
DebbieHurts doni89057
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Your problem and pain sound very much like mine. I've had PMR for a long time, yet can't reduce without flaring in a terrible way. I also have wrist and ankle (not knee since I have two replacements) pain plus the usual shoulder, hips, arms, legs. Right now I am at 18mg and so stiff and hurting I'm in tears whenever I try to do anything. The dr doesn' understand how painful this is! Or maybe I am supposed to live on the couch until I am at 5 mg? My SED rate has been very high at times, lower when I've taken pred, so I know your dilemma. Why not get as low as you can stand it, even if it is just a bit, and on a day when you feel horrible, go have your blood test without waiting two weeks, just to see? Then as soon as you give blood take some pred and feel better. I have done this. VEry naughty, I know, but the test then does tell what is making me feel so much pain, I think. No, I guess you should follow dr's orders. Ignore me, but just know I'm feeling for you.
Michdonn DebbieHurts
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DebbieHurts Michdonn
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Hi Michdonn, thanks for replying to me. Yes, I have trouble with depression, actually chronic major depression, so it isn't just an easy fix to smile. I do smile a lot! But I cry just as much. Yes, I want to take the pred that would help me be active, but my dr has threatened that she'll cut me off pred if I don't reduce. I will see her in a couple of weeks and discuss this with her. Grrr!
Question: will the PMR wear out faster without the pred?
DebbieHurts
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That's a dumb question I just posed. Sorry.
nick67069 DebbieHurts
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celia14153 DebbieHurts
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EileenH DebbieHurts
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"will the PMR wear out faster without the pred?" - the pred makes no difference one way or the other except it manages the inflammation to allow you to have a reasonable quality of life. The PMR may burn out eventually - but there is nothing that will influence that.
Michdonn EileenH
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EileenH Michdonn
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No reason why not - I know people who used turmeric and ginger and ate oily fish and other anti-inflammatory foods who felt a difference if they missed eating as much of them. Sugar and other simple carbs are definitely pro-inflammatory - and lots of people find they make their symptoms worse.
I doubt that will "cure" anything - but it is very likely to help how you feel.
ptolemy Michdonn
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Michdonn EileenH
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Thank God EileenH, I feel good; back on my bicycle working on several projects. Hard to believe a year ago I was in a wheelchair. Prednisone down getting my blood sugar lower, still a work in progress, but better. I do feel the anti-inflammatory diet helps. I don't miss anything bad enough to cheat and find out. Hope you and your husband are doing well. ??
Fizzyjam Michdonn
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Michdonn Fizzyjam
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