Supplements to reduce inflammation

Welcome @debbykreit, My PMR is currently in remission but the last time it was active I started making some lifestyle changes to help with the infllammation. There is another discussion you might find helpful on the topic --- PMR Diet: Foods to eat and avoid: https://connect.mayoclinic.org/discussion/diet-and-pmr/. You might also find this article from Mayo Clinic helpful.

Home Remedies: How a healthy diet can help manage pain: https://newsnetwork.mayoclinic.org/discussion/home-remedies-how-a-healthy-diet-can-help-manage-pain/

Also, something you might want to discuss with your doctor or rheumatologist as some folks with PMR have normal SED rates --- "An increase of erythrocyte sedimentation rate (ESR) at the time of diagnosis is present in all classification criteria [5,6], but it's well known that in a proportion of PMR patients, from 7% up to 22%, ESR is normal."
--- Polymyalgia Rheumatica (PMR) with Normal Values of Both Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Concentration at the Time of Diagnosis in a Centenarian Man: A Case Report: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313638/

Is your doctor a rheumatologist?

Hi debbykreit, Since my diagnosis of PMR followed hard on the heels of a adjuvanted quad flu shot designed for all those "65 and older folks" I have decided not to risk another such flu shot. I never want to go through this again. Everyone's experience with the level of pain is different and other medical conditions play their part in such decisions, as do jobs that require one to take a flu shot. Happily, I'm retired and can make my own decision about the annual flu vaccines that are so broadly encouraged. For me, the risk of contracting the flu is nothing compared to the 24/7 misery I've experienced with PMR, which condition I may have to live with for years. I hope you are able to find help in managing your inflammation if that will drive down the pain. And I have found all John's articles helpful and informative so, hopefully, you will find help there as well. Wishing you the best!

I am seeing a rheumatologist but he is more concerned with getting me off prednisone and taking Tylenol or Advil, whatever I find helps. He also recommended topical cream but I find that useless.

I know that a rheumatologist or even regular doctors will want you to taper off of prednisone as soon as possible but what that means is as soon as your body provides the feedback that you can stop taking it....meaning little or no pain (just my opinion). I just have never heard of any rheumatolgist recommending Tylenol or Advil for the pain and leaving the cause (inflammation) untreated. I hate taking prednisone too and I know you want to taper off of it as soon as possible but I hate the pain of PMR even more. If it were me I might have another conversion and ask him if he can provide a better explaination of why not prednisone when it helps reduce the infammation and makes the pain go away and the Tyelonol and Advil aren't helping.

More info from the article I posted before from Mayo Clinic....
"Lifestyle and home remedies
Over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), are not usually recommended for easing the signs and symptoms of polymyalgia rheumatica...."
-- https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/diagnosis-treatment/drc-20376545

As always just the discussion I needed! Thanks all.

John I have a question about how much pain to tolerate and how much prednisone to use to manage it.

After a year and a half of PMR and tapering, I’m hovering around 4.5 MG of prednisone with mental clarity (finally) and pain free-ish except for the front of my shoulders (maybe infraspinatus area - looking at a diagram). My diet is good, exercise and rest are good … but I fear the pain in my shoulders is causing weakness and subsequently atrophy.

Any advice for addressing one painful area before upping the prednisone?

@jmcc - That's a great question. I based all of my tapering on a daily pain and dosage log that I kept when I started my taper from the 20 mg starting dose. I didn't taper down when it was time to taper down if my pain was above 1 or 2 when I woke up before I took my daily dose of prednisone. My first occurrence took me 3-1/2 years to taper off with the last six months going back and forth between 1 mg and 1/2 mg dose. I always had some stiffness when I first got up (still do!) so I didn't consider that part when tapering. Just getting up and moving around made a big difference for me.

You mentioned diet, exercise and rest are good. Just a thought, I could really tell when I overdid the exercise since my body would let me know about. I still worry about muscle atrophy and try to do more weight bearing exercises but I need to do more.

Here's some tapering guidelines from the British Society for Rheumatology:

"The British Society for Rheumatology guidelines suggests the following method for titrating the dose of prednisone in people with polymyalgia rheumatica:

-- Initial dose – 15 mg, once daily, for three weeks, followed by;
-- 12.5 mg, once daily, for three weeks, followed by;
-- 10 mg, once daily, for four to six weeks, followed by;
-- A reduction of 1 mg from the daily dose, every four to eight weeks"
https://bpac.org.nz/bpj/2013/june/polymyalgia-rheumatica.aspx

Do you keep a daily pain and dosage log?

Hi @jmcc I'm wondering if the pain in your shoulders is related to PMR or something else. I first had PMR, then Giant Cell Arteritis. Over the last six months, I've tapered from 40 mg prednisone to 7.5 mg. My CRP is slightly elevated, about 1.2 (down from 10.6) and virtually all of my pain is gone, except for my right shoulder. I have osteoarthritis, tendonitis and impingement. When the pain is very bad, occasionally, I take acetaminophen, on the advice of my rheumatologist, but I can usually tough it out. I have been going to physical therapy for the last four months and opted not to get cortizone shots to treat the shoulder. Very slowly, doing the exercises, my shoulder is getting better - less pain and slightly more range of motion.Shoiulders take a long time to heal. If you're concerned about atrophy, why not check in with a physical therapist for some gentle exercises? I purchased a shoulder pulley, which helps with range of motion exercises, and use an infrared heating pad (Thermotex) at night to relieve the pain in my shoulder. I hope this helps. All the best.

Hi @debbykreit I posted this a couple of weeks ago, in a discussion about prednisone, but it fits here - so I'll repeat it.

Examine.com (http://www. examine.com) posted a study that 100mg of saffron a day helped alleviate symptoms in people with rheumatoid arthritis, in two groups – those taking prednisone and those not. Saffron reduces inflammation. You can probably find the reference by googling Examine.com Saffron. I was able to find saffron pills - 88 mg - at Swanson Vitamins.

Andrew Weill posted about this recent study in his newsletter (Nov. 24):

When it comes to protecting against autoimmune diseases such as rheumatoid arthritis, polymyalgia rheumatica, and psoriasis, a pair of supplements may be helpful. That’s the finding of a recent study by researchers at Harvard Medical School and its affiliates. They analyzed data from VITAL, the largest national randomized, controlled trial to look at the effects of vitamin D3 and omega-3 fatty acid supplements on the risk of autoimmune disease.

The study included 25,871 adults age 50 or over who were randomly assigned to one of four groups: 2,000 IU of vitamin D3 and 1,000 mg of omega-3s; 2,000 IU of vitamin D3 and a placebo pill; 1,000 mg of omega-3 fatty acids and a placebo pill; or two placebo pills. After about five years, the researchers found that the risk of developing an autoimmune disease was reduced by up to 30 percent in participants who received vitamin D3 supplements, omega-3 supplements, or both, compared to those who took placebo pills. The effects of vitamin D3 appeared to be more pronounced after two years of supplementation.

“Both vitamin D and marine omega-3 fatty acids have immunomodulatory and anti-inflammatory properties,” explains the study’s co-author. “The findings are exciting because no other preventive therapies are available to reduce the risk of developing these serious health conditions.” The research was presented at the American College of Rheumatology’s annual meeting in November 2021.

While this study focuses on prevention of autoimmune disorders, maybe supplementation could help prevent relapse...

A word of caution though, another study posted on Examine.com found that

The heart health benefits of omega-3 fatty acid supplementation have been recently brought into question, with two high-dose trials coming to dramatically different conclusions. On one hand, REDUCE-IT[1] found that 4 grams daily of pharmaceutical-grade EPA reduced the risk of cardiovascular events in people at high risk and with elevated triglyceride levels compared to a mineral oil placebo. On the other hand, STRENGTH[2] found that 4 grams daily of a pharmaceutical-grade mixture of roughly 2:1 EPA:DHA had no positive effect compared to a corn oil placebo. While these two landmark trials disagreed about the cardiovascular benefits of omega-3s, they did agree about one of its possible harms: that supplementation can increase the risk of atrial fibrillation.
.
A recent meta-analysis[3] pooled the evidence from REDUCE-IT, STRENGTH, and four other trials involving omega-3 supplementation to find out if other evidence also points to an increased risk of atrial fibrillation. As shown in Figure 1, it does: overall, omega-3 supplementation led to around a 30% increase in the risk of atrial fibrillation.

It's probably a good idea to do more research on the benefits of omega-3s, appropriate dosages, and discuss with your doctor.

I have a dosage log but that’s a good idea to add pain and even exercise to it. Thanks

Thanks! I’ll give PT a try!