Kenalog v. prednisone

I don't see any reason why Kenalog wouldn't relieve the inflammatory pain caused for PMR. It is another corticosteroid but it has different properties than Prednisone. Unfortunately it has all of the same side effects as Prednisone. It probably isn't used very often for PMR because oral Prednisone is easier.
https://pubmed.ncbi.nlm.nih.gov/37598107/
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I think the goal for treating PMR is to have alternatives that aren't a corticosteroid.

@amroo & @dadcue

This caught my attention in the link Mike sent. To me, it is worth researching for PMR. Especially if Kenalog relieved you of all PMR pain soon after injection and did it using a smaller amount of corticosteroid. (Maybe requiring less than Prednisone because it breaks down slower in the blood and liver??)

A Kenalog injection every two months seems much easier than oral Prednisone every day. A convenient time to bloodwork too.

Hopefully research is being done. What does your doctor say?

Best wishes.

@stonewheel - I haven't seen my doctor yet about it, but I'm going to schedule a follow-up with my rheumatologist to discuss. My allergy doc said I could get a Kenalog injection every 3 months for allergy symptoms, it'll be interesting to see if the relief happens again after my next shot. Keeping fingers crossed.

@dadcue Thank you for the link! The Kenalog injection gives me no side effects, but oral prednisone turns me into an absolute raving, uncontrolled maniac so I stay far away from it.

What you’re describing actually fits pretty well with how Kenalog and Prednisone behave in the body since they’re both corticosteroids acting on the same inflammatory pathways, just with different pharmacokinetics, so it’s not surprising that your deep hip and leg aching from suspected Polymyalgia Rheumatica disappeared after the injection and then gradually returned around 6–8 weeks later as the depot steroid slowly wore off, because triamcinolone injections can provide a fairly long but finite anti-inflammatory effect without the day-to-day dosing flexibility of oral prednisone, and while prednisone is usually the standard treatment mainly because it’s easier to titrate and taper rather than being inherently more effective, there are definitely patients who can’t tolerate it and end up getting partial or temporary control with alternatives like intramuscular steroids, so your response actually supports the idea that your symptoms are steroid-responsive, but it also highlights why rheumatologists tend to prefer oral regimens for long-term management since they can adjust dosing based on sy

@lucasego

"prednisone is usually the standard treatment mainly because it’s easier to titrate and taper rather than being inherently more effective"
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True ... tapering off would be more difficult with Kenalog. Secondary adrenal insufficiency might be more of a problem too.
https://pubmed.ncbi.nlm.nih.gov/19197811/

@amroo

Sorry this happened to you. I have seen this happen to people countless times. Normal people in the hospital for various reasons would suddenly be transferred to a Medical-Psych unit after being administered corticosteroids.

What amazed me more was when a "self proclaimed" PMR expert who thought she knew everything about Prednisone said in all of her years of experience, she had only heard of this happening once. I knew she didn't have any experience to know this happens frequently in a hospital. We didn't say people became psychotic because of the stigma. We used different terminology and said they were having "mental status changes."

@amroo
🤞🏼
I want to know what he says.

@dadcue "mental status changes" is putting it mildly, though that is a much more polite way of saying completely bat-guano, over-the-edge crazy!