Corticosteroid injections for polymyalgia rheumatica
Any thoughts? I am newly diagnosed with PMR, and very reluctant to start prednisone.
Abstract
Objective: To determine the efficacy and safety of shoulder corticosteroid injections in polymyalgia rheumatica (PMR).
Methods: Twenty consecutive patients with active PMR were randomized into a 7 month, double blind, placebo controlled study. Patients received either bilateral shoulder injections of 40 mg of 6-methylprednisolone acetate or placebo (1 ml saline solution). Responders were treated weekly with the same regimen for a total of 4 bilateral injections and then followed for 6 months. Response was defined as a 70% reduction in visual analog scale (VAS) score for pain and for patient and physician global assessment, and duration of morning stiffness. Bilateral shoulder magnetic resonance imaging (MRI) was performed at different times to evaluate the response of lesions to therapy.
Results: All 10 corticosteroid treated patients responded to the first injection with a significant reduction in duration of morning stiffness, VAS pain scale, patient and physician global assessment, erythrocyte sedimentation rate, and C-reactive protein. Interleukin 6 serum levels were significantly reduced after the 2nd injection. In 5 patients, the response persisted throughout the followup period. The other 5 withdrew within 4 weeks after the 4th injection due to recurrence of symptoms. None of the 10 patients of the placebo group responded to the first injection. The difference between the 2 groups was significant (p = 0.03). No side effects were recorded. MRI showed marked improvement of shoulder lesions one week after first injection and an almost complete resolution one week after last injection in the responders.
Conclusion: Shoulder corticosteroid injections seem to be an effective and safe therapy for PMR.
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Best wishes , it sound like you know enuff to advocate for your self. But still the system is so broken.
May I encouraged you to Google for newest info. To keep on top of best meds and treatment.
You need a new rheumatologist. Like most doctors today they don’t care enough to remember who you are. Try another.
I had the injection, and my left hip is much better. I am still on 2 mg prednisone.
My highly qualified Rheumatologist says I may be on prednisone the rest of my life.
I just had a bone density test, and no osteopenia. I take supplements and stay active.
I’m in the process of trying to get the injections. I’m working with my insurance company now. So, I hope the injections work for me. The pain and stiffness everyday and all through the day is becoming unbearable.
My first rheumatologist that never gave me a diagnosis (4 yrs) tried this at my first visit. Yet the fact that I had a systemic response to my symptoms was ignored. Seemed important to me. (I didn't know about PMR yet.) Lasted about 2 weeks. I wonder if it has to be given in a joint or can be intramuscular. However, it would be a lot of shots over time. Seems prohibitive.
So far, the injection in my left hip has reduced the pain a lot.
We never considered injections until only my hip was inflamed.
I had two choices; take more prednisone or try the injection. The injection was only 20 mg.
It seems you were having a localized reaction so it makes sense to use the injection. I was having a systemic problem and got a systemic reaction to what should have been a localized shot.
<p>Injected Prednisone</p><p>My doctor in Costa Rica recommended this. It worked well for me 5 years ago when I had a major "attack" and ended up in a hospital. How can I find a U.S. hospital that will accept an international prescription? Apparently it can only be administered inpatient.<br />Thanks</p>
@dadcue You asked "Have you ever been diagnosed with anything more specific or is it still "presumptive" PMR and/or GCA and/or something else?
I'm being treated as someone with Giant Cell Arteritis (GCA), almost exactly following the regimen used in the 2017 tocilizumab (Actemra) trial published in the NEJM https://www.nejm.org/doi/full/10.1056/nejmoa1613849
Imaging has not shown any of the associated arterial inflammation usually seen in GCA. However the combination of extremely high inflammation blood markers during my initial attack in January 2023, and my relapse in March while taking 20 mg/day of Prednisone led the doctors to this diagnosis; I think they realize they don't really know what I have, but at this point the treatment regimen seems to be working, so I'm not complaining. Basically, after my March relapse, they put me on 60 mg/day of Prednisone for about 5 weeks, then started me on weekly Actemra shots and simultaneously started tapering the Prednisone. Assuming all continues to go well, I'll be off Prednisone in 3 weeks. The Actemra will likely continue for at least another year.
I'm not envious of the long term issues you've had. I'm down to 1.5 mg/day of Prednisone now, coupled with weekly shots of Actemra since April 2023, and so far have not had any relapses.
@jnwwells, other PMR members are talking about injected prednisone in this discussion and may have suggestions for you. I moved your question here:
- Corticosteroid injections for polymyalgia rheumatica: https://connect.mayoclinic.org/discussion/corticosteroid-injections-for-polymyalgia-rheumatica/
Is it possible for your doctor in Costa Rica to make a referral for you to a hospital near you?