Corticosteroid injections for polymyalgia rheumatica

My PMR pain was diffuse so I don't think a "localized" injection would do much good. Taking prednisone orally is a way to administer a corticosteroid systemically. My rheumatologist said I had widespread systemic inflammation.

The following link mentions all of the many ways corticosteroids can be admisistered.
https://www.ncbi.nlm.nih.gov/books/NBK554612/
I remember a time when my ophthalmologist was contemplating the next steps to be taken to get the inflammation inside my eye under control for a severe case of uveitis. He wanted to know if I could handle 100 mg of oral prednisone. I wasn't so sure I could handle that much oral prednisone until he said the next step would be injecting corticosteroids directly into my eye.

Fortunately, the inflammation inside my eye responded to the 100 mg of prednisone taken orally. I don't think I could have handled any corticosteroids injected directly into my eye.
https://www.nih.gov/news-events/news-releases/intraocular-corticosteroids-best-treating-complications-chronic-inflammatory-eye-condition#:~:text=Repeat%20treatment%20with%20corticosteroid%20injections,National%20Eye%20Institute%20(NEI).
Maybe an ocular implant that would have provided a sustained release of a corticosteroid would have be okay ... I don't know.

I had an injection in my right hip after months of being able to sleep only 2-3 hours a night due to pain. The effect was amazing, pain free for a couple of months. Thanks for sharing the abstract.

Thanks for sharing. After 2.5 years, my PMR pain has disappeared, with the exception of my left hip.
For the past 8 months, I have only been taking 2 mg. prednisone daily. My pain level in the morning varies from 3-8.
I have an appointment next week, and thanks to you, I will discuss having an injection.

I'm beginning to think a localized corticosteroid injection may be beneficial to many people assuming they can localize the pain to a specific area. My PMR pain was more diffuse. For me PMR pain was hard to localize to one specific area of my body. The pain was everywhere.

Prednisone often relieves aches and pains caused by many things so prednisone isn't specific to just PMR pain. The mistake I made in the past was to attribute "all pain relieved by prednisone" to be caused by PMR.

I once had severe sciatica with pain radiating to my ankle. I knew it wasn't PMR but I didn't know what was causing the sciatic pain. I went to the emergency room and they sent me home with narcotics as a temporary solution because it was a weekend. The plan was for a more extensive work-up to be done later by my GP.

The radiating leg pain got worse and the narcotic wasn't helping all that much. In desperation, I took 60 mg of prednisone and the pain practically disappeared. I still had acute neurological changes consisting of right foot drop and leg weakness so I informed my GP on Monday He wanted me to come in immediately so he could do an exam. My GP arranged for me to have an MRI a few days later. Urgency wasn't needed because the pain was gone.

The MRI revealed severe spinal stenosis to the extent that urgent spine surgery was recommended by a surgeon who said the nerve roots from my spine were being "crushed." However, the surgeon said I wasn't a good surgical candidate because of all the prednisone I was taking at the time. The plan was to delay surgery for as long as possible so I could reduce the amount of prednisone I was taking. The surgeon said pain would be the "deciding factor" for future surgery.

Later on, my rheumatologist was questioning me about how much prednisone I was taking while reviewing the MRI results of my lumbar spine. I was still on a high dose of prednisone but not having much pain. My rheumatologist acknowledge the pain but she wasn't too pleased with the amount of prednisone I was taking.

My rheumatolgist said she was pleased that the sciatic pain was better. She then explained that taking 60 mg of oral prednisone systemically wasn't what she would have recommended. She said a localized corticosteroid injection to my spine and physical therapy might have been better.

My rheumatoligist wasn't chastising me for taking 60 mg of prednisone "systemically." She just wanted me to understand that a localized injection of a corticosteroid would have been better than systemic oral prednisone.

Perhaps if your PMR pain is localized, this could be an option.

In my case the pain was quite widespread: shoulders, hips, forearms, quadriceps, behind the eye sockets. There was also fever, nausea, and severe night sweats. The pain was 24/7, not just in the morning as some report. It was severe and felt like I had broken bones throughout my body.

I needed something that would relieve the pain throughout my entire body.

In the long run, as I taper off Prednisone (now down to 2.5 mg/day from 60 (sixty) mg/day), weekly injections of Actemra (tocilizumab) are working very nicely for me, and seem to have minimal side effects. Actemra is a much more narrowly targeted drug (it's an "IL-6 receptor agonist") as opposed to Prednisone which suppresses the entire immune system. So Actemra is also localized in a sense; it only impacts a narrow part of the immune system.

@redboat Have you ever been diagnosed with anything more specific or is it still "presumptive" PMR and/or GCA and/or something else?

Have you encountered any problems with adrenal suppression because of being on prednisone? I had to remain on 3 mg of prednisone for an extended period of time. It was difficult to maintain that 3 mg dose but it allowed time for my adrenals to start producing more cortisol. I had to get past adrenal insufficiency before I could taper off prednisone. Getting off prednisone was a true miracle.

After I got off prednisone while still doing Actemra injections, I had a massive flare-up of uveitis. I needed 60 mg of prednisone again. My ophthalmologist said Actemra wasn't optimal treatment for uveitis and switched me to Humira which is a TNF inhibitor.

Uveitis quieted down quickly on Humira but when I tapered back down to 15 mg of prednisone, the pain throughout my entire body returned. We were calling this pain PMR but my rheumatologist also said I had a "full range of rheumatology problems."

I was given the option of either Actemra or Humira but I couldn't take both. Another option was a "shot gun approach" with prednisone aimed at multiple autoimmune problems.

I didn't like the idea of taking prednisone again and especially not on a long term basis. I chose Actemra with the understanding that I could always take prednisone again on a short term basis if I ever needed it.

I no longer think having a single diagnosis is that important. I believe targeting the cause of the chronic inflammation is more important. In my case, inhibiting IL-6 seems to do the most good.

Prednisone doesn't have to be long term. It can be used short term and intermittently which was what I did for 20 years before PMR was diagnosed. I had several "supplemental" steroid knee injections during this period of time too.

I didn't have the additional problems caused by long term prednisone use when I used prednisone sparingly and short term. Liberal use of prednisone and long term wasn't good.

You learned a valuable lesson about steroids. I stayed on them too long with PMR and GCA. Now have steroid myopia. Now reducing quickly with Actemra. Phone and message problems. You may not get this. Do want to talk further. I’m in Florida. Not much guidance here.

My eyesight changed as soon as I started on pred, went from far sighted to near sighted and developed some cupping around the optic nerve, a warning sign of incipient glaucoma.

"Extreme caution should be exercised with corticosteroid therapy for uveitis in highly myopic eyes. It is well known that high myopia predisposes to glaucoma and visual field loss. These eyes are more susceptible to pressure increase following the administration of corticosteroids, the so-called steroid response. In addition to pressure increase, further myopization can occur due to decreased resistance of the thinned sclera in highly myopic eyes."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306119/#:~:text=1%2C2%2C3%20These%20eyes,sclera%20in%20highly%20myopic%20eyes.
My prednisone history started when I had my first flare of uveitis 35 years ago. I was given a handful of little white pills by an ophthalmologist who just said the pills would help the inflammation. I have lost count of how many flares of uveitis I have had since my first flare.

Now my eyes have problems caused of prednisone but my vision is still reasonably good. If uveitis doesn't cause blindness it is increasingly likely that prednisone might. It was difficult for me to understand how the medication used to prevent blindness can lead to vision loss.

I'm very grateful to my ophthalmologist who quickly sees me whenever there is a problem with my eyes. When I report that I suspect another flare of uveitis, my ophthalmologist asks me how soon I can come in and be seen.

You feed back is a lot more than I have had in a long time.
I really appreciate it .
My health care group is a crumbling mess.
That said I am also crumbling and no one is putting the pieces to get her. That equates to early death, homelessness, demoralizing be for death. Like I am a degenerate.
I am so tired now, but in the am I will try again, I have an appointment with my Rheumatologist, he is so over worked, he gets confused who I am. 😫 Ugg