Recently diagnosed, symptom question

Posted by sjf1024 @sjf1024, Sep 2 9:03am

I have been recently diagnosed with PMR and have been on prednisone for about a month. I have noticed a pattern in my physical reaction and am wondering if this is typical. I wake up around 6 am with some low level aches. Do morning routines, make breakfast etc. and take prednisone around 8. During that 2 hour period I can actually feel my body tightening up and the pain increasing. After I take pills it takes another hour or two before the pain level drops and remains low till next morning. Is it typical for pain to increase over the morning period and take that long to decrease?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

I was concerned about possible weight gain when I started Prednisone, really don't like to eat first thing in the morning but wanted to take it right away without having an actual meal. Compromise was a few bites of bread and a cup of water or tea, doesn't take much.

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@michik

Hello @sjf1024 my heart goes out to you as I can relate to what you are going through. The beginning of this journey can be quite confusing on top of being debilitating! Depending on the severity of our symptoms, the length it took to get the diagnosis, the access to our medical providers and the lack of info we get in general it is all quite confusing and overwhelming! It falls on us to do the research, parse through good and bad info, find the reliable forums and try to make sense of it all. Add to that the fact that we are all different and there isn't a one size fits all or golden rule re treatment!
You are just at the beginning of you PMR journey which is still a huge learning curve in my mind, at least that's what it's been like for me.
I was diagnosed after months of being in pain which started in the wee hours of the morning and would progress in intensity through the day. I am 75 and up to that time an avid walker / hiker on the mountains surrounding
the valley where I live. Within about five months it seems that I went from being that woman to one that could hardly come down the stairs in the morning. I was diagnosed by my family Dr. Put on 20 MG of prednisone and within 2 days my symptoms almost disappeared. My instructions were to take 20 MG for a week, go to 15 for a week, then decrease to 12.5 . When I was on 12.5 for 2 days my symptoms came back with a vengeance.
My Dr then advised that I start again at 30mg for 2 weeks then decrease by 2.5 mg every week until I reach a dosage where symptoms start again but they are such that I can live with them.
As I understand it the idea is to try to reach the lowest possible dosage that allows us the least amount of discomfort. I am now at 20mg and so far so good symptoms wise.
That said I have side effects from the prednisone, sleeping, heavy sweating, bowel changes, thinning of my skin, feeling a bit dizzy especially in the morning etc. So I am anxious to get to as low a dose as possible.
I have not been referred to a rheumatologist and wonder if I should but specialists are hard to get to in my area.
My symptoms do get worse in the morning and I have changed my routine so that I eat sooner and take my pills. I can get heartburn easily so I must take them with food. My symptoms are mostly gone within a couple of hours and are bearable compared to what they were pre diagnosis.
I hope this helps and wish you the best of luck navigating through all of this.

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michik,
Thank you for sharing your story. You sound like a wonderful person and patient as well.
I'm glad you're doing better. Your description of the conundrum that is PMR and trying to find one's way through the multiple mazes is spot on...for me anyway!
I wanted to ask you what you consider a level of pain you can live with or as you stated " least amount of discomfort."
I am not medicated and have never received a diagnosis of PMR though I did see a rheumatologist, had labs several times and an ultrasound. But I can tell you, I sure check all the boxes! But I am able to function, certainly not as I did pre-PMR (before Jan '24). I, too, was very active and physically fit...a way of life for me for decades. Now, I can walk briskly for 1/2 hour and do some strengthening, mainly lower body as arms are too sore.
At any rate, I wish you the very best and hope you're back to hiking, walking and a pain level that decreases from very light to non-existent. Sending you light but I have this feeling you are awash in it already.

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Hello Glinda47,
Thank you for your kind words and I am so very sorry to hear you are dealing with pain that has altered your way of life. It is very discouraging when this starts to affect your daily activities but there is no diagnosis and you are still trying to sort out what is going on. That was certainly the case for me for many months. My neck, shoulders, lower back and pretty much from the top of the hips to mid thighs were all involved. Pre diagnosis it got to the point that the pain would wake me up when trying to shift position in bed. Mornings were especially bad. I forced myself to move because I found the more I did the less I would hurt throughout the day. Though certain activities would make it worse. I went to a chiropractor seeking relief and later a physiotherapist who tried a couple of sessions of IMS. The second time I went she said she believed I should see my family Dr as she felt this was possibly more of a rheumatoid issue. So I went, he listened, blood work was done and the PMR diagnosis came about. The prednisone by the 2nd day had taken 90 % of the pain away. I experienced some stiffness in my shoulder and hips but this was nothing compared to pre prednisone. It's mostly gone by 10 AM or so depending on the activities of the previous day. So to answer your question if I can continue to slowly decrease the dosage and maintain this low level of discomfort I'll be thrilled. I am still always very active. Walk a lot with my wonderful dog, about 5 to 7 KM a day, work on our property, gardening, housework etc.
"The side effects of prednisone are no fun, but it could be so much worse, so I feel lucky that compared to where I was last fall I'm doing so much better. I hope to get to the pool and the fitness center once they reopen and maybe back to taichi.
This is not an easy journey! There is so much you have to find out on your own, often when you feel overwhelmed by it all. I do hope you get answers with your situation and some relief soon.
Please don't hesitate to connect with me if I can support you in any way. This forum has so much information but it's not always easy to find what you need. I'm still at the bottom of the learning curve myself for sure...LOL...
Sending you all the warmest wishes and lots of that light you too are basking in.

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@dadcue

This is a typical pattern although I woke up at 3 a.m. with pain. Waking up with pain is a bad omen for the beginning of any day. If the pain wakes you up at 6 a.m. then that is the time you should take your Prednisone dose. Why wait until 8 a.m.?

Prednisone does take an hour or two to be absorbed in the stomach. Prednisone is then converted to prednisolone, its active form, in the liver before it gets into the blood stream.

Taking a small prednisone dose in the evening may help with the morning pain and stiffness. No need to take an additional dose than what is prescribed. I took about 1/3 of my total Prednisone dose in the evening before going to bed and 2/3 of my total dose in the morning. I didn't wake up with any pain in the morning when I split my dose that way.

There are some valid reasons why doctors say to take the entire dose in the morning. My doctor had the opinion that whatever worked best for me was what I should do. As long as I didn't randomly increase my total dose, my rheumatologist was okay with splitting my dose.

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I too mine like that divided the dose up. I have giant cell ..was diagnosed in July 2034 ..caused me to have an eye stroke ..I’m 61 Been on prednisone since July. Tapering down now .. the prednisone has been very hard on my. My nervousness system ..I have had stuttering problems now

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Hi @sjf1024, Your symptoms are typical.

This from Goldman and Cecil Textbook of Medicine, Chapter on PMR and GCA:
"The musculoskeletal hallmark of PMR is proximal, severe and symmetrical morning and even day-long stiffness, soreness and pain in the shoulder, neck and pelvic girdles."

When I had PMR (before diagnosis), I felt like the Tin Man in the Wizard of Oz most of the day with pain and stiffness on a scale of 12 out of 10. It eased up a bit at night, which gave me hope for the next day, but the pains returned every morning. I did stretches in bed before waking up, but that didn't help.

I hope your treatment goes smoothly.

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@edwardh

Food also ensures the med reaches the stomach. My doctor said he had a patient who burned his esophagus when a Prednisone got stuck because he dry swallowed it.

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I always drink about 4oz of water (1/4 cup) before taking any med to "wet down" the esophagus, then take the med with about 6-8 oz of water. My family doctor over 50 years ago taught me to do it - it works so why change. Getting meds stuck the esophagus can me scary - it is avoidable.

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@jabrown0407

I always drink about 4oz of water (1/4 cup) before taking any med to "wet down" the esophagus, then take the med with about 6-8 oz of water. My family doctor over 50 years ago taught me to do it - it works so why change. Getting meds stuck the esophagus can me scary - it is avoidable.

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@jabrown0407
Hi there!
It also helps to take prednisone with alkaline water, water that has been adjusted to +9.5 pH. You can get it where most bottled water is sold. Smart water makes one, and most markets have their own brand. It is also purified and filtered , with electrolytes added for a wonderful flavor. Taking a few sips before you take your pills is also a great suggestion!
Take care and be well!

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