Costochondritis with Prednisone?

Bones, joints and muscles
1

Hi wonderful people,

I'm on 12.5 mg of prednisone, going down to 10.0 mg slowly.  Ever since my journey with PMR began, I've been suspicious about the pain in my lower right rib cage and also in my sternum.

The pain in the sternum has been slowly getting worse over the last few weeks. When I sneeze the pain is indescribable.  It feels like I'm breaking something. The last doctor visit I had, the doc said is sounded like costochrondritis, but how can I have inflammation there when I've been on such high doses of prednisone since the summer?

Any ideas?

Thanks so much, and Happy New Year.

2

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

3

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.

4

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.

 

5

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

6

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

7

Sorry Bob I didn't know you had got replies.

8

I don't know - we go to all that trouble training them up and then they have the cheek to retire!!! Shouldn't be allowed!

Next time you see him you could offer him a reading list. If you are a person for whom pred stops the pain (there are some), if you are in pain when reducing it is quite simple: the dose is now too low. Lots of people are never fully pain-free (he needs to know that) and for them the sign their dose is too low is increased pain. Anyone would think it is rocket science.

And high time to educate the GP...

9

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

10

Bob, I've just read Eileen's reply so perhaps if your PMR spread as far as your rib, given what Eileen has said about cartilage, blood supply and preds perhaps that could be the answer to many of us who suffer from this symtom wether it be the left or right rib and sternum. Christina 

11

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.

12

Like yourself I don't know where I would be without the support, guidance, advice and much more.  You would not get any of this from a gp or even a consultant.  Keep coming back, at your own pace of course.

Stress (that is why I have PMR) and sometimes life throws a curve ball at you.  So I agree sometimes it is just unavoidable.  Good luck anyway.

Pat

13

Hi Bob, just seen your reply, when i was sent for my endoscopy I had never experienced any problems with my stomach, eg, heart burn, indigestion, or any pain what so ever, yet the endoscopy revealed I had this sore where the oesophagus meets the stomach, so don't rule that out.

and the stress issue, yes I suffer from stress too, or rather I did, now, I attempt to stay as calm as possible always. Christina 

14

Hi Bob,

What you are experiencing is what I have been going through for about a year now. My PMR started out with only my lower body being affected (6 months) and then spreading to my upper body (1 year now).

I am currently on 14mgs of prednisone and reducing very slowly.

I also take 50 mgs of azathioprine (twice daily), but no other prescribed medication.

Sometimes I cannot sneeze period and when I can it always hurts. Some days the pain is mild and other days it is very strong. Coughing is only slightly discomforting. My chest area is always sore, varying in intensity from day to day. This applies to the ribs and surrounding area, stretching aroud my back to the rhomboid muscles. I still cannot take a real deep breath of air without experiencing pain.

I keep a daily log of my execise and compare it to my pain on a daily basis. So far the pain hasn't been associated with the specific type of execise I do. I can work my upper body and not have pain in that area. Likewise for my lower body. It seems strange, but that's the way it is. All the pain I am going through floats around to dfferent parts of my body. Nothing is consistently strong in any location. 

I hope this helps and best of luck.

Shawn

15

The steroid injection being rather hit and miss tends to be for joints like shoulder, knee and hip when it has to be located into the joint. Otherwise they can be very effective - though like everything with steroids it does depend on the patient to some extent. I've only ever had good results from steroid injections wherever they were!

16

Hi Shawn, I hope you've read members replies on this thread as perhaps you could attribute what you are suffering from to one of them, there's also a syndrome called tietzes syndrome that is closely linked to costochondritis. Then as I said earlier PMR can effect the rib cage as like Eileen has said because of of the blood supply issue it will take longer to recover even when taking large doses of preds. Christina 

17

Has myofascial pain syndrome been considered? Knots of muscle fibres in various positions in the back and shoulders irritate nerves and cause referred pain - the localisation of the pain depends on which nerves are affected, much like discs causing it. It is possible to use manual mobilisation to sort out the knots - or cortisone injections or a couple of other techniques including massage and Bowen therapy.

18

Shawn,

You are I are experiencing the same thing.  I am beginning to wonder, however, if I ought to get my esophagus scoped.  My doc has always suspected that my condition is being triggered by some other thing, and although I know that's always true with PMR that nagging pain I've always had in my lower right rib cage just might be causing all this.

My doc does not think so, but he's willing for meto undergo any test I desire.  I have a very sympathetic doc.

Thanks!

19

Thanks Eileen, for replacing my incorrect conclusion with a more correct one about injections!

20

There is another problem that can happen at the fibrous junction areas where ligaments meet bone. Those areas are rich in sensory nerves. The ligaments become too loose and it is called Global Laxity.  If you keep getting muscle pulls in areas such as shoulder, elbows, knees, toes, and yes, ribs (any area with a joint) be aware. This disease can cause pain all over.  I can see that this malady can be confused with PMR or Fibromyalgia or be with us in conjunctiion to the PMR with pain all over. Muscular control does not compensate for ligamentous laxity, joint instability may result. Ligament laxity will show up on an upright MRI, the only kind of MRI that will show soft tissue damage. It can only be inferred from a digital motion x-ray. Regular x-rays and MRIs do not show it.