Wrist and finger pain while tapering prednisone

I'm blessed too because I receive Actemra infusions at the VA. The VA submits an insurance claim to my Medicare supplemental insurance. The VA gets reimbursed for 20% of the cost of doing the infusion. The cost of medication is rolled into the cost of doing the infusion. My out of pocket cost is zero since the VA does the infusion.

I don't think Kevzara is available as an IV infusion. Biologics are considered "outpatient medications" when administered as an injection just under your skin (subcutaneous). Outpatient medications are covered by Medicare Part D but it depends on which Medicare Part D plan a person has. I get my medications from the VA so I did pay a small copay when I was doing Actemra injections.

My rheumatologist at the VA felt that Actemra should work for me even though I have only been diagnosed with PMR. I have several other autoimmune conditions including PMR. Actemra is only FDA approved for GCA. I have never been diagnosed with GCA and Actemra isn't FDA approved for PMR or any of my other autoimmune conditions. My rheumatologist submitted an authorization request and got Acterma approved for me to treat PMR.

Actemra can be given in two different ways. The medication can be given as an intravenous (IV) infusion by a healthcare professional in a doctor’s office or an infusion clinic. Actemra infusions take about 60 minutes and are given every 4 weeks. Medicare Part B will cover 80% of a biologic which is given in a "hospital setting" by IV infusion so long as it is FDA approved for the condition being treated.

I'm very pleased because Actemra seems to work for PMR and all my other autoimmune conditions. I don't seem to have any side effects from Actemra.

I had many side effects from prednisone and my overall health and quality of life deteriorated during my 12 years of treatment with prednisone.

I also experienced wrist discomfort while tapering. The description of feeling as if they were "strained" describes it well. It went away after I got of prednisone and no problems since.

I've had PMR since May. CRP of 140 down to 8. Pain almost gone. Pred dose from 60 to 7.5, currently. Recently, I started having the wrist pain. Like RA, PMR also has pain migration. I assume this is just part of that for me. The more I exercise though, the less pain I have.

I am traveling this week with sporatic access to email. I will return yours as soon as possible.

Thanks for your patience,
Doug

I have previously posted about wrist/hand/finger pain. About 8 months into pmr I had horrible left hand pain, no swelling while tapering. X-Ray showed some osteoarthritis and possible cppd arthropathy. My WBC count was very elevated. My PCP sent me to the ER to rule out an infection. There was no infection anywhere. They gave me 60mg medrol in an IV. It hurt so bad I was crying. The IV made it all go away. I had to see a hematologist who decided it was an inflammatory response.
This past spring -4 yrs later, both my hands swelled and were very painful. I was down to 1 or 2 mg prednisone. Xrays showed more advanced arthritic changes and the cppd arthropathy. Rheum said synovitis and inflammatory arthritis. Went back to 10 mg prednisone, hands got better. I'm at 4.5 mg and doing ok. Sometimes I get pains in my hands but I can tell it's the joints in the xrays that are abnormal. I'm soaking my hands in hot/very warm water at night and doing some hand/finger exercises. So far so good. I passed on methotrexate.
My crp was elevated with both hand episodes.

I have found that taking the higher dose about 2hrs before bed helps tremendously. I am now at equal amounts 3.5 mg twice a day. About once a week I will have a flare in my wrists upon wakening -feels like a sprain and hard to hold a coffee cup or OPEN some thing. But the back of leg pain either I've gotten used to or that is waning quite well. I am now starting to taper down 1 mg at a time every five days and hope to be off of the Prednisone. May have to bump up a milligram if I get to a point where the pain becomes unbearable again and stay there a bit but I don't want to take steroids. I never even kept Tylenol in the house before this happened.

I am traveling this week with sporatic access to email. I will return yours as soon as possible.

Thanks for your patience,
Doug

I had some wrist pain when I tapered off the prednisone to 4mg from 10. My PMR came on very quickly with pain at the top of the head, severe wrist, shoulder pain and left knee pain. I did not exhibit the classic symptoms of PMR.

My rheumatologist and my nephrologist are working together to find out whether I have rheumatoid arthritis or PMR.

I used to trust my doctor but he forgot to do the test for the rheumatoid arthritis when I first got PMR. He has made a couple of mistakes lately. I have lost some of my confidence in my doctor. I am now working closer with the specialists.

@pmrsuzie wow i did not know what cppd was ! I'm curious if you asked how PMR and CPPD arthropathy are related ( or not ) in your case ?
https://www.arthritis.org/diseases/calcium-pyrophosphate-deposition
I often see "peripheral or distal " musculoskeletal issues mentioned in association with PMR - such as this reference:
Peripheral Musculoskeletal Manifestations in Polymyalgia Rheumatica
Ceccato, Federico MD*; Roverano, Susana G. MD*; Papasidero, Silvia MD†; Barrionuevo, Alejandra MD†; Rillo, Oscar L. MD†; Paira, Sergio O. MD*
JCR: Journal of Clinical Rheumatology 12(4):p 167-171, August 2006.
Conclusion:
Fifty-one percent of the patients with PMR presented distal musculoskeletal manifestations, with peripheral synovitis being the most frequent one. Patients with PMR with peripheral synovitis did not represent a high-risk subgroup with more severe disease.

@wilmingtonemperor ha ha - don't faint - you are missing a zero -- when put Kevzara (tier five drug) on my compariosn list of for Part D is it >50K$ on my current plan. So i did change plans for 2024.