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Tendonitis (elbow) and Prednisone?

Posted , 8 users are following.

vawils
vawils

I have been on prednisone since May 2015 and recently reduced to 10 mg/day and attempted 9 mg/day but have been suffering from some flare ups and the return of significant muscle aches and pains in the upper arms and shoulders/neck that we are all too familiar with. Once again raising arms above shoulders and getting dressed is difficult at times particularly in the am.   In addition to these muscle pains over the last month or so I have developed a very tender right elbow where it is very painful to lift anything heavy and to even hold anything tightly in my right arm.  I am suspecting that it might be tendonitis from the prednisone and wonder if others agree or if others have suffered from these type of pains.  In contrast to the normal muscle aches and pains which i know are related to the PMR,  the elbow pain is sharper and more acute.  Seeing my rheumatologist next week so want to discuss with her along with some recurrent stomach pains (another issue) which I also suspect may be due to prednisone.  I appreciate as always the great feedback from this forum.

1 like, 13 replies

13 Replies

  • vawils
    vawils

    Posted

    Meant to say that I have been on prednisone since May of 2014.
  • erika59785
    erika59785 vawils

    Posted

    I also have a painful right elbow since yesterday for some reason.......I don't know.  I reduced from 18 1/2 to 17 1/2 (PMR diagnosed since September), and this 1 mg reduction might have caused it.

    I will go back to 18  1/2 for a while and alternate then.  It is strange that such a small amount might cause it, just like in your case reducing from 10 mg to 9 mg.

    I can raise my right arm above my shoulder, but not my left arm.  It is very trustrating, and I am getting Physical Therapy for a frozen shoulder twice weekly.  It has been a month....... it is difficult to be patient with any progress.

    Thought to share my story.

    Erika

  • paul45653
    paul45653 vawils

    Posted

    I refer to the 10% caution that has bee mentioned many times. Some folks can tolerate a larger reduction, some need less not to upset things. I have been on pred for about nine months and consider myself a beginner with tapering. I have gone up and down several times without knowing if what I thought a flare was actually another problem. It takes time and attention to get this right. Good luck. 
  • tina-uk_cwall
    tina-uk_cwall vawils

    Posted

    Hello, you say that you are currently experiencing the return of PMR pain due to a recent reduction, therefore why have you not upped your dose again to the last dose that you didn't experience any PMR pains? As paul has said what may be a mere 1mg reduction, to our bodies it's huge and depending on where your inflamation level is will depend on wether your body can cope with the 1mg reduction. When I reduced from 9mgs to 8mgs in the October of last year I experienced a flare up. I put my dose back up again and and as of today I am at the 9.5/9 dose. I went from 10-9.5. Very small reduction and each dose for 6 weeks.

    it really does sound as if your body just wasn't ready and you need to up your dose so that the preds can regain control and keep under control the present level of inflamation.

    i'm sorry I can't help you with the tendinitis but you say that you are seeing your rheumatologist next week, hopefully they'll have an answer.

    i take my preds with some yogurt and I wash them down with some alpro, almond milk. Don't buy the original/sugar one it's vile, but the unsweetened one is gorgeous. Another brand name for almond milk is breeze, and they can be found in the chiller cabinet in the supermarket. I am also on omeprazole for my stomach problems but my Dr says that as soon as the preds stop then hopefully I can stop them too.

    all the best, christina 

  • EileenH
    EileenH vawils

    Posted

    I think it is more likely to be part of a flare of PMR than tendonitis due to pred. I had that sort of pain for most of the 5 years I had PMR before being allowed to take pred. It was dismissed as RSI (repetitive strain injury) due to keyboard use but a few months of 15mg pred dealt with it as well as all the other tendonitis/synovitis pain I had in my hands and feet.

    What you describe is typical of a flare resulting from attempting to manage on a dose that is too low for the activity of the underlying autoimmune disorder that is the cause of the symptoms we give the name of PMR. 

    I'm sure I must have given you this link before, but if I haven't

    https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316

     is a thread with a load of links in the first post. One is to a paper written by members of the Bristol rheumatology group with their reduction scheme which results in a flare rate of 1 in 5 instead of the 3 in 5 found with most reduction schemes. They take 3 months from start date to 10mg - and then keep the patient at 10mg for a year which is where you would be now with another 6 months to go on 10mg.

    Below 10mg they say 1mg at a time every month - and I suspect this is probably where their flares arise most often. Many of us think this is too fast and I developed a reduction scheme which you will find in posts 4 and 5 (or so) of that linked thread. Each 1mg step is spread over a few weeks - shorter or longer depending on how sensitive you are to steroid withdrawal. The arguments are presented there, I won't repeat them here. There is another similar scheme in circulation, both were based on the way a Swedish gentleman finally managed to get below 5mg and both have been used by fairly large numbers of people already, almost all with success.

    However slowly you reduce, for most people there will come a point where they have reached the objective of the exercise: the lowest dose that manages their symptoms optimally. The aim is NOT to head for zero relentlessly whatever happens. The pred has no effect on the real disease, it just manages the symptoms. Either you taken enough to do that or you don't and the pains return. If that happens and you are not willing to go back to the last effective dose then you might as well just stop taking pred - it is all a balance of benefits and downsides. If you take too little you have all the downsides and no benefit.

    • vawils
      vawils EileenH

      Posted

      thanks for the reply Eileen and your always helpful advice.  I raised the question because the elbow pain over the last month or so was so different (sharper acute pain) then the normal aches and pains that i was "used to" with the pmr.  I thought I had also seen some consideration of prednisone causing tendonitis so just wondering.  I have raised my pred dose over the past week and may have to again to get things more manageable again.  I do see the rhematologist next week and will discuss.  Stu
    • EileenH
      EileenH vawils

      Posted

      The tendon problems pred causes is usually as a result of injections which can lead to infections introduced with the needle, or repeated use or long term high dose pred can result in thinning of tendons making them delicate if you then wrench them. You can develop tendonitis, especially if you are taking quinolone antibiotics as well, but it is pretty unusual for pred alone to cause it - that isn't to say it doesn't happen mind!

      When I had achilles tendonitis due to pred plus ciproflaxine I wasn't told to stop the pred but told to rest the leg that was affected - I was given a strapping to make it less moveable and crutches so as not to have to weight bear any more than necessary.

      Tendonitis is definitely different from ordinary PMR pain, it can be due to it too but you can develop tendonitis anyway. Having PMR doesn't make us immune to other things sad

  • bronwyn97278
    bronwyn97278 vawils

    Posted

    Hi Vawils;  I understand re your ? Tendonites, as I had same in L) upper arm in 2010....I started with physio, and had an Ultrasound to confirm diagnosis.  Radiologist and Rhuematoligist, along with an Orthopaedic Surgeon, firstly suggested having an Hydrocortisone Injection (same as Prednisone, but in a Bolus Dose) into the affected area. This,  however, was not enough to clear up the infected tendon, so progressed to having surgery on same, where the surgeon cleaned out the Pus that was in the area, and which was the reason that it was not healing.  I would suggest you firstly get your GP to order an Ultasound on affected area, to confirm your condition, and then proceed to surgery if confirmed, as I wasted nearly 12 months, while continuing to use arm ( which increased the condition), and prolonged my recovery.  Hoping this is what you are looking for in your questions re Elbow.....I know it is very painful, and surgery does sound daunting; but it was my only solution......please let me know if this blog helped you????    Bron
    • EileenH
      EileenH bronwyn97278

      Posted

      That is a bit different situation to what usually happens in PMR - yours was due to an infection. In PMR the tendonitis, which is part of PMR, is due to inflammation caused by the immune system attacking the tissues, in the same way as joint damage is caused in rheumatoid arthritis. 

      It is true that a steroid injection would help but less likely that surgery would be called for.

    • bronwyn97278
      bronwyn97278 EileenH

      Posted

      Hi EileenH;  I'm sorry that I did not notice the PMR in your case.  I do have Osteoarthrites and Fibromaylgia confirmed, and signs of Chronic Fatigue..and yes my Immune System is very low too....and I know that PMR usually only accurs in adults over the age of 65...I feel that my Tendonites started from an injury to my L) Shoulder, fter falling off a motor-bike, while trying to get off, where My R) leg wouldn't raise high enough and I lost my balance, landing onto my L) side on cement driveway...I didn't think it hurt enough to have a professional look at it/xray...but that is when all started in late 2008, and I continued to work etc with arm/biceps supported...but as mentioned in prior message, this caused a lot more damage/irritation.   I don't believe that the Injections caused the infection, as I know that they were always given under as a sterile procedure (have had many injections into different joints for the ostioarthrites...and not ended up with tendonites in any of those joints...and I had the Tendonites in L) arm prior to receiving Injection into the Bursa of that joint...)  I do hope that you find a satisfactory result, that suits you, as we all are different people/personalities with different preferences...and I know my results/treatment  may no tbe for you...hope you get yours fixed with the best....Bron
    • EileenH
      EileenH bronwyn97278

      Posted

      Everyone on this forum has, has had or is being investigated for PMR and/or GCA - it is the Polymyalgia Rheumatica and Giant Cell Arteritis section within the Bones, Joints and Muscles forum.

      No - that PMR only occurs in over 65s is a piece of misinformation we work hard to dispel! Even officially it is now accepted that patients over 50 presenting with appropriate symptoms should be considered for PMR. Mine started at 51, there are many people on the forums who were about that age when it first appeared, and there are increasing numbers of patients in their 40s being diagnosed with it. The youngest patient in the literature was 24 and about 18 months ago a man of 37 was found at autopsy to have had GCA which was the cause of the stroke that killed him.

      That infection is introduced during the injection is quoted frequently in the literature as a cause of problems. However comforted the patient may be by the wiping of the skin with alcohol it does not "kill all known germs" - it remains a risk.

    • bronwyn97278
      bronwyn97278 EileenH

      Posted

      I am sorry that you sound so upset, even perhaps angry, with my contribution/s....hence I will favour you and discontine, as you appear more enlightened than myself.  I am only replying with my experiences and information gained here in Australia.  Thankyou
    • EileenH
      EileenH bronwyn97278

      Posted

      I'm neither upset nor angry - all I did was point out this is a PMR forum, of course we're all going to have PMR! I wondered if perhaps you were not intending to be here because at least 3 times a week there is a post from someone that the computer has directed here instead of another forum (or the person hasn't used the system properly but I'll blame the computer system).

      I'm sorry if you don't like my way of writing - but I'm a scientist and used to writing in a factual unambiguous manner to answer questions. In any given morning I have probably already written a dozen responses on the various PMR forums so I tend not to waste words and so it sounds, well, brusque. I apologise - because your posts aren't wrong, I just mentioned the other side.

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