Aching chest/rib cage and exhaustion

I have some knowledge on PMR as sufferer myself and my wife has cancer and is treated with a steroid. I am sorry your having to join this group. I have found it to be of great help and educating. We are similar in age. I am 72. I think most everyone feels some level of exhaustion with this disease. That appears to be common. One of the threads on here someone was talking about chest pains. I added that I sometimes feel a pop or a short stab in my right chest but it comes and goes. I have had a couple of chest xrays prior to and since my PMR. Nothing going on. I might suggest that be your first step. I also had a PET scan as part of my diagnosis of PMR. Helpful to know that no cancer was brewing or causing the pain. My suggestion is to get checked out. Chest pain and difficulty breathing is not something to mess with. Medicare will cover it. And its not good to assume its PMR. Lastly your adrenal glands particularly your pituitary gland shut down 2 weeks after you started prednisone. Prednisone is producing all the the cortisol your body needs. It uses glucose to generate so watch your A1C. Cortisol is what your body naturally uses to fight inflammation. Taking a split dose of prednisone and at 20mg your body should be pain free. Provided you dont have GCA and something else is not going on. After 9 months your PMR should at least be losing steam. I was off steroids in 6 months. I really suggest you start educating yourself on Adrenal Insufficiency(AI). Also google cortisol and prednisone. Another would be prednisone withdrawal. Lack of cortisol is going to be a whole new education for you. Otherwise your stuck on this nasty drug and its side effects may be forever.

Here is Mayo clinic comment on fatigue. I have included the link. I may have also misunderstood your comment. It wasnt clear to me where you are on your prednisone dose.

If you abruptly stop taking prednisone or taper off too quickly, you may experience withdrawal symptoms, including:
Severe fatigue
Weakness
Body aches
Joint pain
Nausea
Loss of appetite
Lightheadedness
Irritability or mood swings
In addition to withdrawal symptoms, not tapering prednisone properly could worsen the symptoms you're being treated for. And if you're taking prednisone for a long-term condition, such as rheumatoid arthritis or inflammatory bowel disease (IBD), not tapering properly could cause recurring symptoms to flare up.
https://www.mayoclinic.org/prednisone-withdrawal/expert-answers/faq-20057923#:~:text=If%20you%20abruptly%20stop%20taking,Body%20aches

Thanks for both comments above. I will look at the Mayo link you supplied with comments on fatigue.
To clarify my taper, my rheumatologist prescribed prednisone beginning in September 2023. I was started on 20 mg (10 in a.m./10 in p.m.) and, as many people say, after only two days on prednisone there was a turnaround that was nothing short of miraculous. Since that time, I have been tapering by 1 mg approximately every two to three weeks. She has occasionally varied that schedule based on discomfort or additional support I needed during travel. When the taper hit the 3 mg mark, she increased the time between dosage changes to 1 month. And currently, she has me alternating between 1 mg one day and then 2 mgs the next day since I was noticing that there was more residual pain the lasted throughout the day. I will be doing this for a month and then I will move down to 1 mg each day.
It is only during the last two weeks that I've ever had chest muscle and rib/diaphragm pain and the fatigue that comes on so quickly. I was surprised because I have never had these symptoms before. I guess what it probably comes down to is that with PMR there can always be new symptoms or pain points that pop up.

I have noticed that since my doctor had me taper down to 7.5 mg from 10 mg I have been extremely fatigued. I almost always feel tired and sometimes weak. Did not have these symptoms when I tapered off with my inflammatory arthritis! Just never felt this way, usually a lot more energetic—guess I’m getting older (I’m 74) too!!?

I have PMR and fascia inflammation. If you poke your rib cage and notice specific painful areas these are trigger points. I use a spiked plastic ball and a massage gun to release the stuck fascia at these spots. You could try hard self poking and see what you find!

That's a good link to save. I would agree severe fatigue should be first on the list. It was fatigue that was several magnitudes higher than the fatigue I felt with PMR.

As for body aches and joint pains ... I can only wonder how many times I mistook those pains for a PMR flare. This was especially true when increasing my dose of prednisone relieved the aches and pains. How is anyone supposed to know those pains were a symptom of adrenal insufficiency as opposed to a PMR flare. Maybe if I was aware of these things, I wouldn't have needed prednisone for so long.

It eventually worked out once I realized that inflammation is regulated better with cortisol and the HPA axis. That system should be left in autopilot so we don't need to worry how much Prednisone to take each an every day.

I have decided that I wasn't ever very good at regulating my inflammation with Prednisone. I didn't realize this until Actemra controlled my PMR pain. I had to wing it through the adrenal insufficiency phase of my Prednisone taper. Even my endocrinologist said she didn't know what would happen if I discontinued prednisone after such a long time. It was more about having an adequate cortisol level rather than a PMR flare.

Actemra was doing a great job of preventing a PMR flare as I tapered my Prednisone dose to lower. Maintaining a Prednisone dose of 3 mg for an extended period of time encouraged my adrenals to produce more cortisol. Once my cortisol level was adequate on 3 mg of Prednisone, my endocrinologist said I could discontinue Prednisone without tapering. I tapered off anyway -- going from 3 mg to zero in a couple of days instead of years.

It took nearly a year in total to finally get off Prednisone while talking Actemra instead. It took additional year or two for all the fatique and body ache and pain to feel consistent with the other medical problems I have that explain the pain better. Nobody ever promised me a "pain free life" which was the false promise that taking enough Prednisone would provide.

The difficulty with taking deep breaths since your rib cage and chest muscles are quite sore might be costochondritis.

"Costochondritis doesn’t usually cause any complications. It might be a sign that you have arthritis, especially ankylosing spondylitis."
https://my.clevelandclinic.org/health/diseases/22167-costochondritis
When I had costochondritis, my rheumatologist said it "comes with the territory" I was in. I wasn't sure if she meant PMR territory or inflammatory arthritis territory. I have both so it could have been either one.

Dadcue, I have a diagnosis of costochondritis in my history also! Long, long before my PMR, and long after my reactive arthritis.
I had no idea of a connection but I guess it makes sense now…..

Reactive arthritis formerly call Reiter's syndrome is in the same family of disorders with ankylosing spondylitis. Collectively these disorders are called spondyloarthritis. Collectively, all types combined, spondyloarthritis is more common than RA.
https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/
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Reactive arthritis alone is relatively rare so there hasn't been much research done. Dr. Reiter did "research" but who wants their name associated with that person?
https://www.smithsonianmag.com/smart-news/is-your-syndrome-named-after-a-nazi-130443492/