Prednisilone... Self withdrawal

Hello all. I wonder if some of you would be kind enough to assist me...in getting out of the hole I have dug for myself. I am a 57 year old male. Diagnosed with PMR in dec 2010. I was initially put on 40mg of steroid and felt great in a few days. Sadly I did not know the side effects of steroids at that time. To cut a very long story short.. I now have osteoporosis (hips -0.8 and lower back -2.9) and have been on a maintenance dose of steroids of 10mg per day for last year or so. As I didn't want the osteoporosis to get worse and I didn't like the weight gain of pred.. I self reduced the steroids by 1mg per every 2 weeks. It took 5months to come down to zero. At every reduction the pain, stiffness and aches began to return..but my strategy was that my body would adjust and my body would also start to produce its own cortisol. I have been on zero pred for 4weeks now.. And sadly my body is close to seizing up!! I have terrible pain and stiffness in my hips, groins, lowerbback, legs, and left shoulder. Not sure if the left shoulder is PMR or a frozen shoulder as that is so painful and I can't move the arm up or to the side or up the back..

My dilemma is this... I so want to stay off of steroids but my quality of life is so awful now.. Do you think that if I just took 5mg of pred daily that the benefit to my body would be immediate and also the side effects minimal. I have to decide whether to give in and go back on pred..or whether to try to ride it out and hope the PMR burns itself out quickly. My rheumatologist said that PMR can go in 3 years or so. I have not seen the rheumatologist for over 9 months as there was nothing he could really do. I did try methotrexate for three weeks but it made me so sick so gave that up and stuck to steroids. Also can't go to GP to discuss as he was very off with me last time I saw him a few months ago when I asked him is there an alternative to pred without the side effects. I think I read somewhere that there was a new drug on the market (not yet authorised by NICE) that could produce cortisol in the body. The G P was very dismissive of me and said he had not heard of any alternative. I didn't tell him I had just come off the pred.

Sorry to trouble you on this.. But I am feeling terrible now.. And don't have anyone to speak to on this. The depression feel is coming back also as I feel so rough.

Thank you very much for reading this.

Bob.

Bob57, I have twice attempted a reply to you only to have it all lost in cyber space both times. I would suggessed you look at the pinned threads above your post and look at all the other info and assistance available.

Hoping that these few lines will find their way through as I don't want you to feel that you are alone.

Hello Bob

Goodness, I'm so sorry to hear of the pain you are in. Google The British Society of Rheumatologists Guidelines for the Management of PMR and GCA for guidance in treating PMR.

If you were diagnosed with 'just' PMR, then I'm amazed that you were started on such a high steroid dose of 40mgs. Doses of around 40 and 60mgs are usually reserved for the linked condition, Giant Cell Arteritis.

I don't understand why when you reduced from 40mgs down as far as 10mg you then stayed on that dose for a whole year. Then to reduce by 1mg every 2 weeks was way too huge a reduction as you have so unfortunately discovered. The lower we get on our doses, the slower we need to go as the percentage drop increases the lower we get.

It is important that you get treatment to get the inflammation under control otherwise it can lead to even nastier conditions. Plus you will have an improvement in your quality of life when the pain is under control.

Were you diagnosed from the results of ESR and CRP blood tests? If these were raised, then the tests should have been continued prior to each reduction to ensure that the inflammation was under control.

It sounds as though you have high inflammation levels in your body so, no, going on to a 5mg dose would probably not be sufficient to deal with it.

You really need to be under the care of a good rheumatologist. If, as you say, you don't want to go back to your GP, is there not another GP in the practice you could see?

Can you tell us what part of the country you are in? There are a couple of excellent rheumatologists who specialise in PMR, one is in the Southend area and the other in Bristol. Plus there are several PMR support groups dotted around the country - if there is one near to you at least you won't feel so alone with this illness.

Sorry to hear of your problems Bob - MrsO has really said most of what there is to say so I'll try not to repeat it.

The shoulder is very likely to be PMR - shoulder bursitis is a common aspect of PMR though usually - but not always - both shoulders become affected.

The bad news is I'm afraid at present there is no drug that has been shown to work in PMR other than pred. It doesn't cure it anyway , it merely manages the symptoms to allow a decent quality of life. And as for burning out in a few years - 25% of patients get off pred in less than 2 years - but are at a high risk of a relapse at some later point. About half of patients need treatment for up to 3 to 6 years and the remaining quarter are on pred for a much longer time, often a very low dose for the rest of their life.

However, the group in Southend has done a very small pilot study using a drug called leflunomide in patients with PMR who did not respond to pred or had to be taken off it because of other serious problems. It looked very promising in the just over 20 patients - but there must be further trials to confirm the results and at present it isn't approved for use in PMR. It isn't horrendously expensive (maybe about £100 per month) but it has the potential for some serious side-effects like all the drugs used in rheumatoid arthritis - in RA every patient is different in how they respond, some need multiple drugs, in some a drug stops working after a while, some don't work at all.

But MrsO is quite right - you need a good rheumy and you certainly need to bite the bullet and confess to a GP what you have done and why. If you have osteoporosis there are drugs to help with that if necessary - many of us are insistent we won't take them until we are told we need them on the basis of the dexa scan but if they are needed, fair enough. Had you had one at the outset? You should have had one after about 3 months of pred treatment to give a baseline. Not everyone develops osteoporosis because of pred, even men can suffer from it as they get older though many GPs seem unaware of that fact. I don't think the figure for your hip is osteoporosis, it isn't even osteopenia yet (osteoporosis is a score of less than -2.5 and osteopenia between -1 and -2.5) and it is perfectly possible the spinal results were already there without pred. Were you given calcium and vit D tablets? Have you been offered anything else?

You aren't alone - and there is a DVD about PMR called just that available from the PMR and GCA northest support group website along with lots of other information - google it or find the link in the second post (I think) at the top of the Polymyalgia Rheumatica forum here. But what you need above all at the moment is a referral to a rheumatologist who knows what they are doing.

Don't disappear now you have found us - and good luck

Eileen

Dear Netfred...Mrs O...and...Eileen

That is very nice of you to reply..thank you so much.

I will look at the North East site... But I live near Portsmouth in Hampshire. It would be nice if there was a group or someone I could meet who lived near me..as I have so much to learn no doubt.

To answer some of your points...I was put on 40 mg of pred at the start in Dec 2010 as I could hardly move and the rheum that my GP referred me to said he did not know at that time the exact diagnosis. I had all sorts of tests including muscle biopsy, nerve conduction tests, etc etc and the only thing that came back positive was massively raised inflammation levels in blood tests. I stayed on 40mg for a few weeks and then the rheum reduced the dose by 5mg per fortnight till I reached 15mg. I then reduced by 1mg per fortnight till I reached 10 mg. the rheum said that I should stay on that dose for a few months and see how I get on. I flitted between 7-10mg over the following months. Every time I went as low as 7mg the symptoms began to get worse. Then I stayed on 10mg as maint dose for over a year. I didn't have a déxa scan till June last year and its that that showed the osteoporosis scores. I self medicated myself down to zero over the last 5 months. As I said neither the GP nor rheum know this. I so hoped that the PMR had burnt itself out..it obviously hasn't!!!

I have gone back on 10mg from this morning as life was no longer worth living as I have returned to an awful physical condition. Can hardly move and the muscles are so stiff and painful. My legs feel as though they are made of tin. Hopefully the 10mg will kick in quickly.

I was so fit and so active and whilst I may still look like that to outsiders..as long as I don't try to move...inside I know how I now feel. I wonder if the 35years of high pressure life in the business world could have contributed to how I now am.

I would settle for my legs returning to normal..my muscles easing..my hips working..and my lower back being ok again. I so hope the 10mg can deliver this. My self reduction to zero strategy was pointless and silly of me I suppose. Perhaps I now need to accept how I am..not fight it every inch of the way..and give in to even longer term pred medication. I feel so sad and run down with all this now..and I don't think I will trouble my GP again as I don't think any of them understand the effects of all this. I will mention to my rheum at my next appt even though that's months away.

I tried to have some massage therapy thinking that would help but it made things so much worse including muscles seizing up even more and moving the horrible virus feeling around my body. I have spent a fortune on alternative treatments over the last 4weeks..inc Chinese medication.. Acupuncture..herbal remedies etc etc all to no avail.

Thank you all so much for your caring words.

Rob

The NE site was the original online helpline - open to everyone to read for advice because before it was set up there was nothing to be found about GCA - which is what the lady who moved and shook to get it going had. She met some others online through this forum - and the rest is history. It provides everyone with info and has a forum which functions as a virtual support group - even to the sitting around and having a conversation about ANYTHING, albeit a bit slowly as it doesn't have a chat function :-(

There are quite a few support groups around the country and MrsO is probably the one to ask - I don't even live in the UK! She runs one which meets at Chertsey.

Massage CAN be helpful but only VERY gentle, the same applies to physiotherapy - the therapists MUST know what they are doing and many don't. I used Bowen therapy very successfully for the first 5 years or so when I had PMR but it hadn't been recognised so I had no treatment with pred. It kept me mobile and relatively pain-free. Heat often helps - try an electric blanket in the morning BEFORE you get out of bed. Once you are able to get out of bed and move some that will will help with the stiffness - don't remain seated for a long time, get up and move around every 1/4 hour or so and do very gentle stretches. A warm shower also often helps. Once I was in less pain I also found Pilates and yoga helped - but you MUST have an aware instructor who will adapt things for you and allow you to know where is the stop point. Mine were outstanding in that respect.

"I was so fit and so active and whilst I may still look like that to outsiders..as long as I don't try to move...inside I know how I now feel... I would settle for my legs returning to normal..my muscles easing..my hips working..and my lower back being ok again."

Yes - we know, we were too and we would love that as well! If you have lower back problems then Bowen therapy might well be worth a whirl. I sat for 2 days last week with a warm hot water bottle across the base of my spine - with excellent results it has to be said!

"I wonder if the 35years of high pressure life in the business world could have contributed to how I now am" - don't know about the 35 years but PMR is often associated with a history of stressful events, appearing after a bereavement, retirement or other event like big house moves. What is certain though is that after that sort of life and being able to cope as a high achiever the massive lifestyle change required is even more agonising than it is for some other people who weren't so active and energetic. And it is even worse at a young age - I was 52 when my PMR first became noticeable.

Don't write off the GPs - there must be others in the practice and one of them may be up to scratch. Therewas only one really aware one in my practice of 7 - but once I started seeing her, the others started to catch up. You can also "interview" other local available practices, you might be lucky.

You could call your rheumy's secretary and explain the situation and ask if your review could be brought forward. And there is nothing to stop you asking if he does private work - a single private consultation is probably more point that spending money on Chinese medicine and then you can return to the NHS cycle! Acupuncture doesn't work immediately - often you need 10 or more sessions to achieve pain relief so if whoever you saw led you to believe it was an instant cure they were lying!

Actually - the speed of your reduction to zero was not only pointless and silly - it may have made things worse and contributed to much of the pain and feeling ill than if you had reduced very slowly. Normally, the starting dose in PMR is 15mg so you could try going up to that and staying there for about a month before starting to reduce again, preferably by 1mg at a time but 2.5mg might be OK down to 10mg. It is such a shame you wasted that year at 10mg. I am great at 10mg, 9mg is OK but 8mg is my limit - no matter how slowly I reduce it doesn't work, even taking 7 weeks to get from 9mg every day to 8mg every day. I accept that - whatever the risks of pred it is my life-line. The alternative is being an invalid and in pain and miserable.

Don't allow yourself to get depressed - part of PMR is depressive mood anyway, having a chronic and incurable life-changing illness is also depressing. Yes it is chronic and incurable - but it isn't terminal and it DOES go into remission. Unfortunately, it does seem more persistent when you are younger when it starts.

Give the docs another chance. If you were a woman I would tell you to go to the doctor and not get all dolled up as most women do - let him or her see you without the slap and see how difficult it is to move. Let them see you in tears if that is where you are at home - but you aren't a woman! Nevertheless, when the doc asks "How are you today..." DON'T say "I'm fine." You aren't - and if you were you wouldn't be at the doctor's.

Don't give up yet,

Eileen

Hello again Bob

I do hope the 10mg is working and you are feeling much better already.

If you are, then don't attempt to reduce from that dose for at least 3 weeks, and then not by 1mg a fortnight as you have done in the past but at the most 1mg a month and then only if your symptoms allow. You really need blood tests to guide you, especially as you say they were "massively" raised at the outset.

On the other hand, if you haven't had any improvement, then, as Eileen has already suggested, 15mg should hopefully do the trick.

However, you do need to be under the care of either a GP or a rheumatologist - you must not be left alone to manage this illness. There are too many risks to having untreated inflammation coursing around your body. So try and find another GP - remember they are being paid to care for you - and ask for referral to a rheumy now rather than waiting many months for your next appointment.

It's not surprising that you feel run down and depressed - being in constant pain is very depressing. We all know because we've been there in our days before and since diagnosis, but as soon as that pain is under control you will feel so much better, and, with good management of your illness and the right steroid dose, you will be on the way towards the illness burning itself out rather than going backwards again.

Unfortunately, there isn't a support group in Hampshire yet. There is one in West Sussex that meets in the Goring area, and I run one in Chertsey, Surrey. However, that is possibly too far for you, being some 58 miles away from Portsmouth although, having said that we do have a member who travels from Havant which is some 54 miles distance.

Keep in touch and it would be wonderful to hear that you are feeling somewhat better, and that you have made an appointment with a Dr. All the best.

And what MrsO didn't mention is that there is one lady who attends that meeting from S. Wales! I wouldn't hesitate to commute to her group if I lived that distance away!

However - this forum and the other one with the link in thread No2 at the top of this forum will provide you with a load of support. The northeast support group forum is much less formal than here, has members from all round the world and interacts in a similar way to a "real" support group. There are a few men - though you are greatly outnumbered by us ladies I'm afraid! That is the nature of the beast - more females affected than males. Plus we are more likely to admit our problems and gather for a natter :[

Eileen

Oh c'mon Eileen, you can jump on a plane!! Well, perhaps not "jump"! :D

Thank you very much Mrs O and Eileen for your replies. It is very humbling to know that people care so much to take the trouble to reply. A big thank you.

I must admit...I have never accepted or given in to this condition... I have fought it all the way.. Self reduced dosage thinking I know best... And most of the time made myself so much worse. For two years now I have done this. Now that I have been so bad as a result of my latest 'I know best strategy' and reduced to zero from 10mg.. I now need to at last accept my limitations and follow the medical advice given, and indeed your wonderful advice, and stick to a dose for a lengthy time.. And only reduce to a strict slow programme once my poor body and system is ready for that. My stupidity for two years must have been a 'male thing'... Having been at a very senior level in business calling the shots... Maybe I just continued that into this condition.. I now accept that I have made things worse for myself, and I hope albeit belatedly I can recover over a period of time. I seem to have a mindset where I hear the rheumatologist saying that this may take 3 plus years to burn out.. And I totally let that go over my head and I act like it will go in months.

I feel a lot better already having been back on 10mg for three days and whilst my shoulder is still bad and my legs are still stiff, I can certainly feel the improvement. I need a fixed plan now.. That I give my word to myself, and to you, that I will stick to. The key decision is whether to now stick to 10mg for a few weeks and then try -1mg per month reduction till I plateau at an acceptable level... Or to stick at 10 mg for a few months before trying any reduction... Or whether to go up to 15mg straight away for a while to fully get my body back in order. There is a trade off between the lowest possible dosage v feeling well and able to move.

I have phoned the rheum secretary and she has brought my next appt forward to 30 April.. Still a long way away but it's the earliest she could arrange. I will confess all to him at the appt.. And then sit on the naughty step for an hour or two!!! I will then stick to whatever dosage he says. I need to view pred as the only thing that allows me to move and have a quality of life...as opposed to seeing it..as a toxin to my body.

I would be very happy to meet up with you and your group Mrs O whenever it's convenient for you.. I could even drive up and give a lift to the member that lives in Havant if they would be happy with that.. Havant is a PO postcode just like Portsmouth is.

I haven't re approached my GP surgery yet.. I thought I would await the outcome of the rheum appt first and see what the 'plan' is.

Thank you again

Bob

Hi Rob

I've sent you a private message with my contact details. Once I hear from you I will be happy to send you details of Surrey's next meeting.

I'm so glad you are getting some relief from the 10mg dose. As to whether you need to stay there for a while or increase to 15mg then only time will tell. If it was me, now that you've had a few days on 10mg and are feeling much better, I would give it a few weeks and if no further improvement, then you may need to go higher. Don't expect to be totally pain-free though - very few sufferers have that luxury down through the doses, although you might be one of the lucky ones.

Have lots of rest to enable the steroids to do their job, plus some daily walks as far as comfort will allow, and whenever you reduce always choose a quiet week.

Meanwhile, at least you've managed to bring your rheumy appointment forward. Perhaps it would be wise to get CRP and ESR blood tests carried out a week or so before your rheumy appointment so that you and he have something to work on. If you still don't feel like facing the Dr, then perhaps you could ring the surgery and ask for a telephone appointment with one of the Drs, explain that you've brought your rheumy appointment forward as you are having problems and asking if they could leave you out a blood test form for collection.

Bob

I forgot something!

"My stupidity for two years must have been a 'male thing"

Don't beat yourself up about it, at least you're getting back on track now. I do think men are more inclined to bury their heads in the sand - we had one gentleman who thought it would be ok to start at the bottom dose of steroids and work his way up. Unfortunately, it's a complicated illness and many of us have learned the hard way that we can't fight it - we do have to give ourselves loads of TLC......and stay positive.

Bob - we might be just as close for you to meet - in West Sussex close to Worthing? Or you can go to both!

Let me know if you would like the details, or check them out on the websites.

Nefret/Catie

Hello Mrs O and Catie

Thank you both for your replies. To increase my learning curve on this dreaded PMR I think it will be good to go to both of the groups for the next meeting if possible. I am not sure where the private messages come through Mrs O but I will look and reply.... And Catie perhaps you will kindly let me know of your group details and venue/dates etc.

I will indeed contact my GP again soon to appraise him of the situation and hope he adds value..or at least listens to me with a modicum of interest!!!

Thank you both again

Bob

Dear Mrs O

Being a techno phobe... Sadly I can't find where the private messages come through... Perhaps you could give me directions as to how to locate them and access... My life was so much simpler when I had a secretary at work..now I have to do all this techi stuff myself!!!!

Thank you

Bob

When you sign in and reach this thread scroll to the top of the page on screen. There you will see a light green band, the patient.uk title, below it is a darker green band to access other parts starting HOME and finishing in orange and below that is grey band with "my messages" and "edit my profile" on the right hand side. Click on my messages and your messages should come up listed like emails (as I remember!). Even the CEO must be able to get into his emails?

I still think this forum was easier to use before they introduced the "new improved" version - I'm sure it is fine for the young and healthy who are lest likely to use it. Anything becomes a trial for the ill and adding in age and medications merely compounds the felony However, in fairness, after a YEAR it is slowly getting better again. Like us we hope :D

Eileen

Bob

Haven't you received an email from Patients Experience into your Inbox notifying you of my message? If not, then I'm not quite sure how you would access it. I'm really a techno phobe too, especially as I didn't have a secretary at work - I was that secretary!!! Alan (Moderator) - can you help here please?l

However, although this doesn't answer your question at the moment, in order to send a private message you just click on 'Reply to this discussion' in the green box at the bottom of the page, as you do usually when you want to reply to a post, and you will see that in the profile section under each person's name at the side of each of our posts is the word 'Message' in a red box - just click on that and another page pops up where you can type your message and send in the usual way.

Thanks for coming to the rescue, Eileen. Lordy, how long have I been using this site. I've now found a couple of messages to me that I never knew existed - just expected Pat.Exp. to notify me in my Inbox - they're more organised than I thought :[ :D

"Anything becomes a trial for the ill and adding in age and medications merely compounds the felony"

Doesn't help me: not ill, not on medications, and I'm not owning to "ageing", being just a mere youngster! :D :D

Thank you Eileen... I found it....

Oh for the old simplistic days...a letter in the post... or a short walk to the red phone box... thats the speed I would now like life to return too!!!

Regards

Bob

Greetings, Just this evening I found your forum and have read most of this conversation as you've encouraged bob57 in his quest for pain reduction.

I live in the US, in the state of Michigan. was diagnosed with PMR in June of 2012. My sed rate was normal yet the pain and symptoms clearly showed PMR. My dr. (thankfully) knew exactly what it was and gave me prednisone.

bob, let me assure you it's not a "male thing" to want to pretend this is going away or that you can get along without the steroid. I dislike taking this medication! Oh how I want to be done with it asap! I was on 25 ml. at the start and have reduced down to 8 but I have pain every day. I tried to go from 10 to 5 in just one day and suffered terribly for it.

After reading your posts I went immediately to my supplement supply and took more calcium! I have been taking vitamin and mineral supplements, plus omega 3, and an immune support combination from Shaklee company, this winter I've not had the flu or a cold! That's nice.

Besides the side effects of pred. the tough part of living with this is that we look normal, and it's a difficult pain to describe to people. I don't talk about it, only if someone asks me how it's going. Then I'm honest with them. ..

Thanks for being here.. there are no support groups in my area for this ailment.