Pain in sternum

Shirley,

Are you taking the Pred with food or on an empty stomach? It can do damage to your digestive system including your esophagus.

After 3 years I'm sure you know this.

I just started taking Omeprazole(nexium)as I've experienced similiar symptoms. It has helped.

Just a thought...

Pain in the sternum and ribcage seems like definitely one of the pmr symptoms I experienced.  It was quite bad when first rising from bed, and made sneezing very painful at any time of day when my pmr flared.

I picked my rheumatologist's brain at my last visit, and I asked about the mechanism that actually causes the pain.  He dismissed my suggestion of vasculitis and told me that there is a covering layer on certain connective tissues that gets attacked by the immune system.  Ligaments and tendons if I recall.  This is relieved by prednisone, just like all of the other pmr symptoms.

Your description is a bit vague - but it could be costochondritis, inflammation of the cartilage between the ribs and the sternum. It isn't uncommon in PMR and with pred. 

Or it could be myofascial pain syndrome - what Dan describes probably, inflammation of the fascia which sheaths muscle groups, the transparent skin that you see around pieces of meat. It can be inflamed, responds to higher doses of pred but then returns as you reduce. However, oral pred isn't the best way to deal with it - steroid injections and manual mobilisation of the trigger points that form in the muscles works far better with fewer side effects.

The trigger spots are due to local concentrations of the same inflammatory substances that cause PMR except in PMR they are systemic (all through the body). The trigger spots tend to form in pairs on either side of the spine, in the shoulder muscles, about rib level and in the low back, where the baby's dimples are. They can cause muscles to be tight and even to spasm - and then it leads to irritation of nerves in the area and that can cause referred pain in the appropriate area. In the shoulders the pain will be arms, shoulders and neck, at rib level it goes round into the ribs and in the low back the back muscles spasm and cause sciatic problems right down into the legs. It can be one-sided or both.

I had steroid injections and a technique called needling into the back muscles which were as hard as boards, done by the pain clinic. A physio also did manual mobilisation of the trigger spots. There is no point trying to do ordinary physio until the back muscles are soft again - otherwise the spasms get worse. I live in Italy so what is available may not be the same as you can find on the NHS. But there are complementary medicine and physiotherapy practices that offer the needling technique - you'd have to find one though. I also found Bowen therapy helped a lot and so have others on the PMR forums - it didn't completely eradicate it but every little helps. It doesn't help the PMR, just the add-ons but you know after 1 or 2 sessions that it is doing something, even if at first it is temporary. There is probably little point carrying on for more than 3 or 4 sessions if you can't feel some difference.

Shirley,

I have had "costocondritis" almost ever since the beginning of my journey with PMR.  I have to hold my sternum when I sneeze or I see stars.  I also have had pain under my right rib cage -- and a strange "tingling" sensation under my right clavicle ever since the beginning (2 years now).

I started at 20 MG, which almost totally knocked out all the pain immediately from my back, legs, shoulders, etc.  I'm now down to 6 mg using the slow method.  

But the costocondritis seems to have been constant throughout the reduction, which probably means it's not the direct result of the PMR?

All the best,