PMR Flair up From a Virus?

Hi @christopherc, You pose an interesting question. You will notice that we modified your discussion's title a little to better describe what the discussion is about and hopefully bring in more members. Here's some information from Mayo Clinic on the topic.

"Can a virus cause PMR?
New cases of polymyalgia rheumatica tend to come in cycles, possibly developing seasonally. This suggests that an environmental trigger, such as a virus, might play a role. But no specific virus has been shown to cause polymyalgia rheumatica."
--- Polymyalgia rheumatica - Symptoms and causes: https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/symptoms-causes/syc-20376539

Did you have a significant flareup with the flu or COVID?

Thanks, John. I was aware that PMR might be triggered by a virus. I am interested in whether people with PMR have had a flare up or relapse during a virus. I’ve had a flare up with a cold.

My PMR was started by getting the Covid 19 shot. June 17, 2021, I had the shot and the next day my neck and shoulders were stiff. This was the trigger. Been on prednisone since then. I had no issues prior to the shot. I never took another shot.

I had a flare (could barely use my arms, and was in pain) after a mild case of COVID. Was on 6 mg before; went up to 10mg for two weeks. I started another taper from there: 0.5mg every two months. My Primary Care Physician said that slow rate would reduce the chances of another flare.

Hi, Christopherc, Okay, so this is how I understand it. A healthy person has working adrenal glands, which produce cortisol and send it out to your body as needed. So, when you become emotional, or active, or sick, the adrenals recognize this and they send out more cortisol to get you through your current "crisis". But when we take prednisone, your adrenal glands basically shut down and don't produce cortisol, because they sense that the prednisone is doing their job for them. The difference is, WE are controlling the amount of prednisone your body is getting and it's a stable amount every day. There is no producing more or less based on your changing needs each day. So if you get sick, or are more active than usual on a given day, or having something else that is stressing you out, the prednisone might not be enough to take care of those "special" occasions like your adrenal glands normally would. So this is why, it's a good idea when you're sick to up your dose of prednisone. (Of course, you would need to discuss this with your doctor.) Further it's also a good reason why you should pace yourself - not doing too much physical activity that is unusual for you two days in a row, and if your are fatigued, you need to allow yourself to rest. Recently I had covid, so I upped my prednisone by 5 mg/day (with my doctor's blessing) for 6 days. Then went right back down to my normal dose within 2 steps. No problem. I hope this answers your question. Just a little bonus aside - they also gave me Paxlovid and I rebounded on it. Covid for over 2 weeks. But again. All went well.

Aspine ,

Thank you so much for the thoughtful, clear and thorough response. It makes infinite sense. I have had the same experience as you regarding Covid. I didn’t realize initially that the covid rebound I had a few days after completing the five day course of Paxlovid that it was more l than just a cold. Since I wasn’t on the antivirals this time I felt a great deal of pain throughout my body and thought it was mostly due to PMR. Your explanation sounds right on the money. I completed a one year course of prednisone in the middle of March and I’m now on Celebrex to lessen the residual pain I have every morning and whenever I’m stressed. I’ve been anxiously waiting for my natural cortisol to kick in and come back to normal levels but it’s been almost imperceptibly slow. I’ve read that it could take from 6 to 12 months to return to normal. I’d be interested in whether anybody has any feedback on how long they think it took in their case once they went off prednisone. Thanks again for the great response. Good luck to you in your treatment.

With regards to taking prednisone, I have had probably more than the average experience. I was on a large dose (40mg) a few years back and also Entacort (Budesimide) 9mg for a Crohn's flare that resulted in appendexitis and surgery and it was after the the steroids cleared that I had my PMR experience. The steroids cleared in January 2017 and I had my adremal gland tested toward the end of 2017- about 9 months after stopping the steroids. They did the ACTH response test and I did double my production of cortisol after an hour but at the begining and after 30 minutes, I was under the low cut off. So I was running on the low side but did finally respond appropriately.

At the present, I am on 12 mg of pred (and not doing as well as I would like) and recently had a physical challenge. My horse bucked me off (he had a good reason- long story) and I definently felt my adrenal gland was not keeping up. I felt uncharacteristiacally weak for 2 days. So taking pred does have its price.

Just to illustrate how different we all are: I am admittedly a "low reactor" to sudden stimulae and my husband is a quick reactor. That I run on the low side for natural cortisol is not surprising. When I am given pred, I really feel it. My husband was recently given 40mg (with a 5 day taper) of pred for an allergic reaction. He felt nothing! No aggitation, no extra nervous energy, nada. That amount would have lit me up like a Roman candle. One size certainly does not fit all. Let's hope all our drs. recognise that.

No one knows what causes PMR. The citation above is representative of theorizing by some medical scientists, and it makes logical sense that there may be a virus, as yet unidentified, that causes or triggers PMR. If so, it would seem to be a persistent virus, like zoster or HIV, that hides in the body sometimes ("remission") and then pops out again. So what? Since no one has discovered such a virus, science cannot combat it. But I hate to feel helpless, as do so many posters here. There really is something we can do to fight PMR: work on boosting our own immune systems. It is the immune system that eliminates viruses (like colds or flu) from our bodies. Even if PMR does not result from a virus, a strong immune system is the best health tool we have. Nutritionists, physical therapists, doctors all have ways we can support our immune systems. Again, even should we fall short of achieving the powerful immunity we desire, just the fact that we are doing something, not just suffering from PMR, is itself a helpful psychological boost. [I have no credentials for this opinion.]

It has been recently released that they think that Crohn's is caused by a certain genetic set up and a case of a common GI virus. (I think it was Norwalk but not sure.) It would set the body up to attack its own tissues. Seems very likely that PMR would be similar. But somehow I think the "reactivity" of owm immune system would be a factor. One of the most important -and complicated-thing the immune system does is tell self from non-self. Pretty amazing, I think.