I was diagnosed with ostearthritis in the hip 3 years ago - but because I developed PMR around that time I have never experienced any pain from the hip due to it being masked by the steroids. However, 2 weeks ago my Prednisolone strength was reduced to 10mg daily from 15mg. I am now experiencing terrible pain in my hip and leg ( due to the arthritis which I was totally free from before.) I am sorely tempted to up the dose!. I am due to see my doctor next week about this. Cannot take any other anti inflammatory drug whilkst on the steroids. Would be interested to know if anyone alse has had this trouble?
Are you sure it's not mostly PMR caused by that very large drop of 1/3, 15 mg to 10 mg? Recommendation is never to drop by more than 10%. You've dropped three times that amount.
You probably should increase your dose, not because of possible OA pain, but because it's most likely your PMR infalmmation is no longer properly controlled.
You need to consider that the PMR is what was causing you hip pain to begin with as it can cause significant hip pain (unilaterally or bilaterally), because you said the diagnosis came about the same time as you developed PMR. Lots of people have significant degenrative changes on x-ray and don't necesarily have much in the way of symptoms. Anyway, I agree with Anhaga that you've cut your prednisone way to fast or too far (or both) so I'd go back to the dose you were pain free and go from there. The "terrible pain in my hip and leg" doesn't sound so much like arthirits anyway as it would be a dull ache, exacerbated by walking, etc. (I'm an orthopedic surgeon BTW).
Hi Gillian,
yes I have polyarthritis and bursitis of the hip as well as PMR so have had excessive pain to, and since steroids 4weeks into them I have had no pain in my hip either.
You may have dropped too much, I think it's 10% drops only from 15mg so I would go up to 15 and when settled and pain free do a 1.5 mg drop and see how it goes. There is a slow reduction regime others follow on this forum and most people find that works for them. Good luck.
Hi. I have not had hip problems bur I can't help thinking that a reduction from 15 to10 in one move is far too much too fast. I am obviously no expert but I would have thought a 1mg per day reduction over a period of weeks would be better. R
Oh, I wish my orthopaedic surgeon understood the ramifications of PMR, then I might have some real diagnosis. As well as PMR, I have spinal stenosis and have lower lumbar disc problems. Have had steroid injections in spine and hip but they did not work. Am on 20mg of Pred but I suffer from leg pain and aching in lower back, I find walking difficult and have numb feet. (I sound like a wreck, but not so long ago I was very fit). Consulted with an orthopaedic surgeon at a spinal unit in UK but he seems to think he cannot operate and anyway due to constant UTIs would be unwilling to try. Not at all sure where this leaves me, except hurting, feeling on the scrap heap and a bit alone. I guess you have no magic wand to wave, do you? 😞
Yes Gillian, I have hip and spine problems (arthritis and disc issues) so understand completely your confusion about what is arthritic pain and what is PMR. I always put it down to arthritic pain but since finding this forum, am now not so sure as everyone seems to think PMR is the culprit for most pain. It is hard to differentiate the difference between the two.
Sorry Loulie... sounds like you're having some real issues. Perhaps when you get the PMR more under control (lower prednisone doses) maybe your risk for complications after spinal surgery would be lower as well? I'm not familair with UK referral patterns but I would suggest you consult another well thought of spinal surgeon for a second opinion. And if the answer is the same then perhaps they'll have suggestions on how to make your life more tolerable. Good luck!
Thanks Ouzel. Yes, I had forgotten that prednisone was also a barrier to operating. Hey ho! I will re-address when my dosage is lower. Thanks.
Hi Gillian, poor you. Are you saying you have been on 15mg of pred for three years? Or have I misunderstood. The aim of the pred is to sort out the PMR not the osteoarthritis, you should not be increasing the dose to sort it out, but use other pain killers if needed. I sympathise as I have severe osteoarthritis in one hip and need the hip replaced. I agree the pain can be pretty horrendous (not mild!!!). I am currently on 6mg of pred. As the others say the drop from 15mg to 10mg is pretty drastic and could cause all sorts of probems.
I'm going on almost thre years with PMR, and I can say that the bursitis pain in my left hip can be quite severe, enough to prevent normal walking.
The occurrance of this pain is quite sensitive to my pred dosage level.
I'm currently at 4mg/day. The bursitis, when it occurs, usually sets in late in the day. It gets better over night, while most of my other symptoms worsen!
I take the 4mg of pred first thing in the morning, which seems to be the most effective at reducing my daytime fatigue symptoms.
10mg isn't a barrier - I know a few people who've had hip replacements on pred, at least one was on 10mg and subsequently was able to reduce and get off pred once the hip pain was gone. It was almost as if the hip pain fed the PMR.
If one surgeon won't agree - shop around because it is their individual preferences and prejudices that are important. One may not - another will.
That drop was far too big for a PMR patient - never more than 10% of the current dose is recommended and even that can be too much for some people. It is also possible there is an element of bursitis - the pain can be very similar to OA in the hip.
If it were me I'd go back to the 15mg and then reduce 1mg at a time. Particulalry if, as you imply, you have been on 15mg for the last 3 years. Even so, a 33% drop is ridiculous - it may work for a patient who has only been on pred for a couple of weeks. After more than a few months on any dose of pred you will struggle with large drops.
I think most surgeons will operate at 7.5mg of pred or lower, but you must not take Methotrexate it seems.
Hi Gillian. I am so sorry to hear of your pain. I say that with great empathy because of my history with PMR. I started with left hip pain that wasn't present in May 2008 when my 3rd son was getting married. But by late June 2008 I had to use a cane because of of the left hip pain as my fourth son was getting married. August 2008 we had relatives visit from Germany which was really hard because it was for 2 weeks and by then both my hips felt as though ground glass had been put into each joint. When they left I scheduled an appt with an orthopedic surgeon I had seen before for right hip bursitis years earlier in late August. His P.A. gave me a cortisone injection in the left hip after diagnosing bursitis. The left hip hurt more than the right at this time. This helped but in late September I developed severe tendonitis of the left proximal forearm. I could not see regular GP and went to urgent care, and was given a prednisone dose pack. After getting better immediately after two doses of prednisone, I thought I should inform my GP that I had been diagnosed with same thing in shoulder, and thumb earlier in the year,starting in January, and wondered if he thought I might need a sed rate and CRp done. Sed rate was 64 and CRP was elevated too. He put me on 20mg per day and then upped it to 40 mg a few weeks later due to the pain. I was 61. Thus it went on with decreasing dose and by August of 2009 I was using a walker to get around at all. I complained of constant hip pain bilaterally, was on 13 mg a day of Prednisone. The rheum said I would still have pain from the PMR but I could only stand for 5 mins, without sitting and then still had pain. I took Tramadol without relief. I decided to see a doctor I had seen before for back pain because I thought that might be the source of my pain. He saw me walk with the walker into the treatment room and said immediately, "Pat, your hips are gone. " By the way I walked he could tell the hip joint had dissolved. He said he would get an MRI but in the mean time sent me to an orthopedic surgeon. I had the left hip replaced in Sept. 2009 on 13 mg of prednisone and the Right one of in February 2010 while taking 9 mgs of prednisone. I had Avascular necrosis of both hips caused from prednisone . Not everyone gets this but you asked about hip pain. Keep your next appointment and I hope they can give you relief.
Forgot to mention that hip x- ray in August 2008 showed no osteoarthritis but with direct pressure on Lt. Hip joint there was tenderness. I agree with Anhaga about dosage drop too. Hope it gets better soon. Pat
I have avascular necrosis in one hip which the orthopaedic surgeon said had been caused by the pred. In fact what he said is it looks like the steroids have rotted away your hip!!
Any idea why?
I am not really sure why, I suppose it is more directed at people with RA as they often need replacements. It may be that surgeons are being puritanical and as you are put on some pretty hefty drugs during hip replacement, antibiotics, strong opioids, blood thinners for example, they don’t want things interfering with them. I will try and find out. I have heard that some surgeons ask people to stop taking glucosamine even.
What were your initial symptoms for this? Will you be having a hip replacement? It sounds like it would be very painful. 💕