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Wrist and finger pain while tapering prednisone
I know there are similar threads within other discussions, but wanted to start a fresh, focused discussion.
I've been tapering from 20 mg of prednisone since mid August and am down to 13mg as of today. I had a couple of "mini" flares, but jumped back to previous dose for 2-3 days and resumed taper for the next two weeks successfully. At the 20mg I was pain free and with the tapering, had very mild pain (1-2/10) and stiffness in the mornings for the first couple of days that was pretty much gone by the next taper down. However, at my last taper from 15 to 14mg, my wrists and some fingers were at a 3+/10 level and very stiff in the morning. By late afternoon it is down to a 1+/10 level. The wrists almost feel like they are sprained and the lower palms like they are bruised. The annoying part of this is opening containers, manipulating small items, playing golf in the morning on weekends, etc. I chalk up the finger pain to normal arthritis wear and tear.
To keep the tapers going, I'm willing to put up with wrist pain at the current level as long as my other joints remain at the low levels. Everything else is going well so far, inflammation markers are back in normal range, just had a bone density scan that looks good and above normal and most prednisone "issues" are much better.
I do a split dose and have been holding the morning to 10 mg and tapering the evening dose. Maybe I should keep the doses equal?
Has anyone else had this issue and if so, have you found any solution for relief?
Thanks, Terry
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My PMR attacked my hips and shoulders, however after taking 20mg of prednisone all symptoms went away. I then cut down to 15 mg still without any symptoms. Then I got to 8 mg and my PMR came roaring back, attacking my hips and wrists, but not my shoulders. The wrist pain was the worst, like others said I can hardly function until around 2 when it goes away. I'm going on a cruise, so I've gone back up to 15 mg in hopes my symptoms will disappear long enough for me to enjoy the cruise. I'm using the Voleren which helps and a paraffin therabath. They both help. After I finish traveling, I'll start cutting back but much slower. I've got to get off Prednisone. Appreciate all the comments .
@murphy2370
I can relate to everything especially how PMR roared back when I reached 7 mg of Prednisone. It might vary by a mg or two but I'm now convinced those "flares" were caused by adrenal insufficiency when I reached the physiological dose of Prednisone relative to the amount of cortisol the body needs to regulate inflammation.
I still have hand and wrist discomfort and occasional "hand spasms." I don't know why this happens but I had a spontaneous rupture of a tendon connecting my thumb when I was on Prednisone. I also had many trigger fingers along with other hand problems while on Prednisone. I don't get those trigger fingers anymore but my hands are still sore but not like they were when I took prednisone. My rheumatologist says it is arthritis.
I'm off Prednisone now because a biologic allowed me to taper off Prednisone. The biologic controlled PMR as I decreased my Prednisone dose below the "physiological dose" relative to cortisol. I can go on and on about adrenal insufficiency from long term Prednisone use but the following link describes what happens.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12378006/
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Coincidentally, I just finished a 20 day cruise to Australia which included a week in Hawaii and and a week in Sydney, Australia. I took some Prednisone with me but I didn't need any, I just had to get back home in time for my next infusion of Actemra.
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2 ReactionsThanks, Mike... I appreciate the help. I get the trigger fingers frequently, and terrible wrist pain. What biologic are you taking? My rheumatologist at the VA has told me she wants to put me on some new drug that will replace the prednisone. A buddy of mine is on Embrel, for his autoimmune issues. He says that works for him.. I think Embrel is an injection. Thanks for your help.
@murphy2370
Hi Jim ... we have the VA in common. The VA was able to get Actemra (tocilizumab) approved for me to treat PMR. That was when I was able to get off Prednisone the first time.
The first time I tapered off Prednisone, I had a flare of another autoimmune disease unrelated to PMR. An ophthalmologist at the VA insisted that Actemra be stopped and switched me to Humira. Along with Humira, 60 mg of Prednisone was restarted.
Humira probably helped the autoimmune condition that caused my eye to flare up. However, Humira didn't control PMR very well when I tried to taper off Prednisone again. I had recurring PMR symptoms when I reached 15 mg of Prednisone.
Multiple autoimmune conditions can be difficult to treat. Eventually I was switched back to Actemra by my rhematologist. I was able to discontinue Prednisone a second time. My ophthalmologist was opposed to switching me back to Actemra. However, now my ophthalmologist says Actemra "seems to work" for the autoimmune condition that caused uveitis to flare up.
https://preventblindness.org/uveitis/
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I have a type of inflammatory arthritis that is associated with uveitis. TNF inhibitors like Enbrel and Humira usually work better than IL-6 inhibitors like Actemra which only targeted PMR. I needed to be on either a TNF inhibitor or an IL-6 blocker but not both.
Some of my trigger fingers and other hand and wrist problems were attributed to inflammatory arthritis more than PMR. The tendon that ruptured was thought to have be the result of long term prednisione use but that was never confirmed so that was simply called a "spontaneous" tendon rupture.
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4 ReactionsI did have just this issue right after tapering off Prednisone. Wrist and hand, particularly the thumb. I can relate to the frustration over opening jars. Not wanting to get involved with any more meds, I went to an occ therapist who gave me finger exercises to do with a rubber band and foam ball. The exercises only increased the pain, so I stopped, but possibly this would work for you. The rheumatologist said my PMR had abated, so the hand and wrist pains were due to osteoarthritis. After a month or so of being kind to my hands and wrist, the pain went away. There are a lot of mysterious aches and pains that come and go at this stage; I’m in no hurry and prefer to keep things simple, since that strategy has worked well for my health over the years. But I can certainly understand the wish to be done with this debilitating condition and not give any more of one’s life over to it.
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