Treatment for Polymyalgia Rheumatica
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- Опубликовано: 3 июл 2024
- Rheumatologist Dr Andrew Jordan discusses how he approaches the treatment of Polymyalgia Rheumatica.
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My PMR was triggered by a COVID infection. For three years I assumed that I had long COVID. A change in physicians, my new m.d. recognized my problem as PMR and prescribed 15 MG Predisone. In one day I went from being a basket case to "normal" and pain free. One day!
Thanks for sharing your story. I hope things stay that way. Well done!
How ling did you take the drug?
So many people on diffrent channels have said their onset was right after covid and vaccine. I counted 50 on 3 channels. Scary. My first 3 vax no problem than came on suddenly. Very scary.
My PMR was also triggered by a COVID but it started from the booster shot.
I'm too afraid to get any more boosters. I was in so much pain and immobile I could not get up to pee on my own power. I was hospitalized for 3 days before I started to get better.
Thanks for your good comment on tapering the prednisone dosage with time..
Excellent summary.
Thank you so much for presenting this video! I've been recently diagnosed with this from my primary physician. I saw a Rheumatoligist late last week. I'm following up on some tests she's recommended. Afterward she'll recommend some sort of medication or I may have to stay on Prednisone. Right now the Prednisone is keeping the pain away. It was excrutiating. I'm so glad to get some relief.
Thank you for sharing. Glad you have been managed well. Good luck with it.
Thank you 🙏🏾
Thank you Sir!
Glad you found this useful
I have an Elderly Lady Friend 76 who has just become afflicted with PMR 6 months ago diagnosed this past week and just started Prednisone. Her symptoms were the pain and numbness combo.
I've just been diagnosed with PMR. I have to take 5 mg 3 times a day. But when it was reduced to 2 5mg a day, I was then back to square one, not able to get out of bed couldn't brush my hair or teeth, or even shower.
I hope you are felling better.
You should take your dosage all at once in the morning. Not 3 times a day.
Recently been diagnosed with PMR and found your video very valuable.
Thanks
Thanks for taking the time to give us positive feedback. Appreciate it.
@@bjchealthAU if I could just ask a quick question. I still seem to be experiencing severe pain even after starting prednisone. Is that normal? Any info I’d helpful atm.
Drew
@@ACIDSOAP Drew, I think it is best that you follow up with your treating professional to query the correct dosage and confirm the diagnosis. It is too hard to say on such a forum.
@@bjchealthAU I understand.
Thanks again
Very helpful.
Thank for your positive remarks. Appreciate it.
Seeing my doc today. Been suffering for a year. Tells me it is osteoarthritis. Went on prednisone for 3 days one year ago for a skin issue. Pain free for 3 days. After 3 days no prednisone was back in pain . 😮. Can't even sleep lately. Need to drill it in his head that it could be pmr.
Thanks for sharing. If unsure, please see a rheumatologist if you can. I do hope things get better soon.
I spent two months figuring out I had PMR , had days I couldn’t get out of bed ,doctor put me on 15 mg prednisone and within 6 hours I felt normal again, in another week I am to cut the dose to 12.5 mg for next month 🤞
Thanks for sharing. Glad to hear you are getting better.
Same for me.
@@fionaforward3358 I’m down to one mg of prednisone and going of it in about two weeks, hope you get the same result
I was on 30 mg for a month and now have dropped to 25 mg but the pain has come back not as bad after this month I am going down to 22.5 for a week and then down to 20 mg .
Decreasing the dose after only 1 week is pretty quick, especially if you had pain return. Are you seeing a rheumatologist?
Very helpful videos - this and your previous one. Is it possible to have both PMR and RA? If on methotrexate already for RA, would steroid treatment for the PMR be added on top of that, or would you recommend a different approach altogether?
Very good question! You can have a “polymyalgic” onset of RA. The initial symptoms may look like PMR as only shoulder and pelvic girdles are affected. Later on, if more peripheral joints are involved (hands, knees, feet etc), it may become clear that the initial symptoms were actually RA rather than PMR. In this case, treating with RA medications like methotrexate would be appropriate and this can be combined with prednisone as well.
Thank you for making this video! I'm currently being diagnosed with this. I've been in horrible pain in my pelvic girdle for 30 days. My doctor just put me on prednisone 3 days ago. I noticed most of my troubling pain is going away. I'm still sore though. I will feel realitively better before I go to bed. At night after an hour of me falling asleep I will wake up with my hips in lots of pain. Should I be taking my dosage before bed? Should I split it up during the day? I currently take 40mg in the morning. Thanks for your time!
Hi Jeremy, firstly, I'm glad you are feeling better. Unfortunately, I cannot advise you as it is very much dependent on your medical history and how you present. These are good questions and should be asked of your treating physician. Please reach out to them.
I have the symptoms of this but my labs are normal…hips and shoulders and wrists.. super frustrating to get diagnosed. Can a ultrasound find it?
An ultrasound is only occasionally helpful for diagnosing PMR. I would suggest you see a rheumatologist for review. A small percentage of people can have PMR with no inflammation seen on blood tests.
How about a plant based diet instead of pushing meds. I've had it for two years and started at 10mg and I'm now down to 2 mg. As a vegan, it has helped inflammation. An anti inflammatory diet makes a difference.
One's diet can help. Multiple lifestyle factors are important. Definitely not just medications. Here's our series on anti-inflam eating - ruclips.net/p/PL41CFAEFAC3FF42EB
I discovered years ago when I was competing in bodybuilding when I had sore joints I would take baking soda to get rid of the acidity in my joints would feel better the next day. That’s the same with PMR if you get the acidity down in your body it does help, you still may need meds like prednisone but again any little assistance
Thank you very much for your video - it's very informative. Recently I was diagnosed with PMR. My rheumatologist prescribed me prednisolone for 10 days 8mg, 6mg for 20 days, 4 mg for 30 days, and 2mg for another 30 days. This is three months treatment plan. I tried to reduce my medication to 6mg after 10 days as I have been advised but the pain returned. I'm back on 8mg again. Unfortunately, I see my rheumatologist just after 3 months so I have to make my own decision on how much to take prednisolone. I'm confused now because everywhere I read or listen to PMR treatment should last from one year to 2 years and in higher doses. I would appreciate your comments. Thank you.
You should contact your treating doctor for advice. PMR often requires treatment above 5mg daily for many months and entire treatment course usually takes 1-3 years depending on the individual.
Usually start at 15 mg for a month, then 12.5 for amonth, 10 for a month and then drop by only 1 mg every month. Relapses can occur when below 10. What country are you in. Never heard of such a short asnd low treatment.
I have had hip, hip flexor and hip bursitis pain and been seeing a sports doctor for that. But also for the last 8 months I have had severe hip girdle pain at night, effect my sleep. I have flare ups, which totally knock me around. I now have upper jaw pain at night too.
Just had a body scan that apparently showed nothing. Blood test had little high markers but again no action or help given. I see a new doctor in May, as I have lost confidence in this one.
Have a rheumatologist appointment in July.
Feeling extremely frustrated and angry that my symptoms keep getting brushed aside.
What can I do for the pain in the mean time??
Sorry to hear. In the interim, try to get some pain relief and something to help your sleep perhaps from your GP. In terms of your hip pain, perhaps a local physio can help you. If you have pain from you hip as a result of bursitis and you get pain lying on that side, prolonged sitting and walking, your options are:
- lying on the opposite side and having pillows in between your knees
- using an underlay mattress which has "eggshell" cushioning
- not sitting in chairs/seats that are too low
- walking with a wider gait
The recommendations above are very general though. My advice is to seek some help from someone experienced in treating hip pain. Good luck and thanks for sharing.
Any answers yet? I was just diagnosed and in one day prednisone has 95% reduced pain. Sleeping was a kilker. So sore in the am. Felt like a truck hit me or a 95 yr old. Need to be on it a yr plus though.
Hi I was suspected of suffering with PMR but my blood tests came back clear but I seem to have all the symptoms of it hip pain stiffness in my upper arms fatigue etc I’ve been prescribed codine phosphate for pain relief but doesn’t help much was wondering if there is a specific blood test for it? Thank you for making this video very informative
Inflammatory markers are the main test for PMR. There are other causes of shoulder and hip girdle stiffness, so you should speak to your treating doctor about other possible causes.
Are you over 50, female and white? They are MOST common group to get it. Did you see rheumatologist? Crp and esr most common test showing inflammation. Ive read a few, maybe 10% show nothing but taking the med for a couple days shows,if you get instant relief and can confirm pmr
Sir plz who treatment medicine ?
If you are asking who you should see, you should seek advice from your doctor/physician. The will then confirm the diagnosis and advise on management.
Hi Andrew,
Thank you very much for your video, I found it extremely useful. My father has been suffering from PMR for about 2 year now. He has been on medication the whole time with no real benefits yet. My question relates to the underlying cause of the inflammation. My Dad is a pretty typical 68 year old, loves a beer (10+ per week) and he lives on his own so normal food consumption looks like breakfast cereal, white bread sandwiches, pies, pizza. My question is, in your opinion would a diet that promotes more inflammation lead to suboptimal results from the prescribed treatment. And, have you ever had patients that have drastically improved from changing their diet, exercise and sleep while supplementing with a treatment plan as you have described.
Thank you very much in advance.
Hi Ryan, thanks for watching the video. There is no doubt that pursuing healthier lifestyle choices can make a huge difference in treating all forms of rheumatic disease. It improves pain, function and quality of life. I have seen many cases where inflammation markers (CRP) drop with weight loss. From your description, it seems like there is plenty to be gained with your father making some healthier choices. Your challenge is making him want to change, as he needs to take ownership of his health problems.
@@bjchealthAU Thank you so much Andrew.
Good video, thanks.
Well, my doctor(s) had me on 9mg of Prednisone and the pain from PMR subsided right away. but after a little over a month they urged me to taper off of it, which I agreed to do.
Presently the PMR has roared back and it is much more debilitating than before, (full body myalgia).
I then decided to go to an alternative healing clinic (out of pocket $$$), these doctors urged me to go back on Prednisone, and would even authorize a return to a 9mg prescription right away, if I choose to.
Awaiting response from my main doctor and my rheumatologist about my consideration at this point to make that decision.
Is long term 9mg really that dangerous?
Healthy 71yo, non-smoker; non-drinker; very active runner, and I run everyday.
Thanks for sharing your story. There are side effects with all medications especially if taken long term. As mentioned in the video, the aim would be not have someone on prednisone long term but unfortunately there are a percentage of people who have to be on it indefinitely for PMR. The aim would be to keep you on as low a dose as possible whilst still managing your symptoms. It sounds like the taper period was too quick and hence you got a flare. Perhaps re-watch the video as this is explained quite clearly.
I've had PMR for 5 years now, starting dose was 10mg and was very effective, I went on to develop TA, was increased to 60mg, and reduced over a long period of time. I'm at 7.5mg now and the pain is not under control, I tried increasing to 12.5 for a week (so I could reduce quickly again), didn't work, have now jumped to 20mg, still so much pain, I've also had an increase in temporal pain in the original side and sometimes in the opposite side, literally terrified of TA coming back. What can I do to get this pain under control, I'm at my wits end and so depressed about it, because not only is it pain it's dreadful fatigue aswell. I also have Fibromylgia so it's a real double whammy. I haven't been able to reduce below 6 or 7mg without a flare up. I know methotrexate can help but I've heard so many bad reports on it so very reluctant to go on it, plus the pmr obviously hasn't abated so I clearly can't come off prednisone. I wonder if you'd have any thoughts as to what I should do or what dosage I should be at, many thanks in advance.
I’m sorry to hear you are struggling. I can’t give direct medical advice on RUclips. In general, other options to treat temporal arteritis include methotrexate or tocilizumab. You could discuss this with your treating doctor and also ask your treating doctor their opinion as to how much of your pain is from fibromyalgia, as fibromyalgia is not treated with immunosuppression. I hope that helps.
@@bjchealthAU thank you so much for replying I do appreciate you taking the time to. I'll ask my doctor again, think he doesn't really know the answer or really know what to do with me. His new recommendation is Ramacaide, but having researched it, I'm not going to go ahead with that. Thank again🙏
@@susanwaters2662 Good luck with it.
Methylprednisolone injectable is a safe and effective way to treat PMR, but they wont give it to me, for a start with injectable it's not going through your liver and kidneys, when I was in South Africa a Dr gave me one injection, the next morning it was like being reborn, 100% no pain, this lasted for just over three weeks, when I returned to the UK I asked my Dr about it and he said he couldn't prescribe it unless a consultant prescribed it. dead end..
You sound about like me
My mother is allergic to steroids... Any other non steroidal treatment..?
Prednisone (corticosteroids) are the mainstay of treating PMR, although there are a couple of other options that should be discussed with your treating doctor. It is extremely unusual to be allergic to steroids, perhaps the problems are related to side effects from prednisone - this is typically related to how high the dose is and may improve with a lower dose. You should discuss the complicated issues with your treating doctor.
What is used if you can't take prednisone?
Prednisone is the mainstay of the treatment regime for PMR. Occasionally rheumatologists will use methotrexate and there are a number of clinical trials looking at using biologics in PMR
I've been diagnosed with PMR. I've had to give up my job. I have been suffering for months. Prednisone does nothing for the pain. I was going to work in slippers as my left foot was so swollen I couldn't wear shoes. I also had swollen hands. I stopped the prednisone and the swelling went down. The flare-ups are so bad I have to use a walking stick otherwise I fall. Is this PMR?
I have had ONJ after 4 years remission of PMR. I have osteoporosis . I have taken prednisone several times per year for eosinophilia asthma. Haven’t been on pred for 3 years. PMR is back. What can I take for my pain instead of Pred? I take Panadeine Forte morning and bedtime. Arava at morning. 1 Panadol rapid morning and night and 2 at afternoon. Don’t want to be taking all of these drugs!
It's very hard to comment and it would be inappropriate to give you advice on this platform. I would suggest addressing all of this with your rheumatologist. And seek a second opinion if you are unsure about the advice you are receiving. Good luck with it all.
@@bjchealthAU well that wasn’t very helpful!
@@sharenmoore8270 We cannot give you medical advice without knowing your full history so it would not be appropriate to answer specifics. It may actually be dangerous to do so.
But, doesn't prednisone, especially taken over long periods, like a year or two, completely destroy the immune system and lead to biome problems such as candidiasis and oral thrush?
Of course. KenDBerryMD has all the answers, w/o pills.
Thank you. I have watched quite a lot of Dr. Berry's presentations. Is there one, in particular, you can recommend that would enlighten me regarding a functional medicine (no pill) approach to cure polymyalgia rheumatica?
@@crism7684 I would simply recommend the carnivore diet. The strictest is grass fed/finished beef/lamb, salt & water. Less strict is all animal meats and dairy. In general no processed food and no plant food. How fast people recover depends on how strict they are.
The only supplements I use are vitamin D and Mg.
Once recovered, generally 90 days, more variety can be brought in and trialed.
Thank you, Steve. I've just started carnivore. A little difficult finding a variety of grass fed / grass finished meat here in Alabama, though. @@stevem8318
@@stevem8318seriously? No one can afford that! Nor is it healthy.
I was on predisone but had n very bad reaction that put mevin a coma for 14 days. Now I take .5 ml of CBD oil 2ce a day. No adverse efdects at all
And the CBD controls the pain? I'd be interested to read your response.