PMR Flare up: Any suggestions on what to do?

Welcome @bevletsgethealthy, The hand and wrist pain with swelling could also be carpal tunnel. Is it both hands and wrists that have the pain and swelling? Have you discussed it with your doctor/rheumatologist?

It is both hands. Th hand that bothers me the most had surgery for carpal tunnel just over a year ago.

I haven't had the surgery for my carpal tunnel but did have one cortisone shot when it was bothering me a lot on my left hand. When mine was really bad and it made it harder to sleep I found some gloves that immobilized the wrists which helped some. I was also told to try and keep them elevated when I could. It might help to talk with your hand doctor if possible to find out if something else besides the PMR is going on.

Before PMR, I had osteoarthritis in my hands with minor inconveniences, but no consistent pain. I have had hand and wrist pain that kept getting worse after PMR was diagnosed. I could barely use my hands due to swelling and pain, especially in the morning. My rheumatologist says it is inflammatory arthritis and put me on hydroxychloroquine in addition to the prednisone. His thinking is there are better meds to deal with arthritis than prednisone, and the hydroxychloroquine will help with the arthritis as well as help with the tapering of prednisone. I was not happy to add another med to the mix, but it seems to be working, and I am tolerating it well. I began this journey in April of this year and came home on 30 mg of prednisone. I am now down to 8 mg and am currently tapering by .5 mg every two weeks. I am hopeful.

Hi John. Thank you for your reply. Saw the Rheumatologist today. Definitely a Pmr flare up. He has given me a Rx for methotrexate as well as B9 and Furosemide to help with the pain so l can taper off the prednisone. Looking for info from people who have taken this drug. Thanks Bev

Furosemide is lasix (a diuretic) and B9 is folic acid- which may do some good but not for pain. Methotrexate is an immune modulator which help some but not others. Please let us know how you do.

furosemide is lasi

Has anyone had to increase their prednisone dose to 50 mg per day for a flare?

For a PMR flare, 50 mg would be a lot of prednisone. You should consult with your doctor before taking that much prednisone.

What dose of prednisone are you currently taking? Increasing your dose from 10 mg to 50 mg is one thing. Increasing from 40 mg to 50 mg is another thing.

30 to 40 but not enough and thus 50. I’m an orthopedic surgeon

Are you prescribing prednisone to yourself? Did you diagnose yourself?

When I was first diagnosed with PMR, I ignored what my rheumatologist told me because I thought I knew everything about tapering off prednisone. I had a 15 year history of recurring uveitis along with reactive arthritis. My ophthalmologist frequently prescribed 60 mg for uveitis. My ophthalmologist would adjust my dose upward if needed until the uveitis responded. I was then allowed to taper myself off with instructions to call if I had difficulty with tapering. I could always taper off quickly in a month or two so I rarely had a need to call.

In retrospect, I didn't know anything about PMR but I thought it would respond to prednisone the same way as reactive arthritis and uveitis did ... wrong! The treatment for PMR is "long term" as in years instead of months.

I got off to a bad start because I thought I knew everything. I got a "non compliant" label put on me because I kept increasing my dose. My rheumatologist started me on 20 mg but I increased it to 50 mg because it worked better than 20 mg.

My rheumatologist wanted me to find a "stable dose" of prednisone that worked to control my PMR symptoms. The stable dose I eventually found was 40 mg but my rheumatologist said it was too high a dose for PMR. My rheumatologist would have liked something less than 30 mg.

I refrain from giving medical advice due to my training as a nurse. However, I suspect something else is happening. It might be PMR and something else. In my case, it was a "full range" of things in addition to PMR according to my rheumatologist.

I had the same rheumatologist for 15 years after PMR was diagnosed. We found ways to work together. I eventually got off prednisone but it took a long time and an entirely different treatment plan.