Have you checked your Vitamin D?

Over the past 4 - 5 days the pain in my right shoulder, arm and bicep has signicantly increased, I am no longer able to lift my arm over the top of my head. The 20mg dose of Prednisone that i take daily doesn't help at all (4 (5mg) pills so i compensate by taking a couple of Tylenol extra strength capsules which help somewhat for the pain ( no more than twice a day) I.ve seen my Rheumatologist concerning, I even suggested i get a few x-rays. She told me there's no need for these at this time and to stay the course and let the Prednisone kick in and do it's thing.
Is there anyone out there experiencing the same pain in their right shoulder and how they are dealing with it.
Best way to describe this pain is a very sharp, deep pain, no aching. Usually lasts most of the day nowadays with very little relief. On the pain scale 1-10 (10 being the highest) on average my pain is at a 6-7 with spikes during the day that can hit 9. Appreciate any feedback.

When my PMR was at its peak, before I started treatment, I had shoulder problems. For both shoulders, I couldn't raise my arms above shoulder level. But the left shoulder was much worse than the right. Certain movements of my left arm hurt so bad I felt like screaming. One really painful move was to let my arm hang straight down, turn my hand to point backwards, and then move my arm straight back. I could do that with no problem with my right arm, but with my left arm moving just a couple of inches backwards was extremely painful. Once I got diagnosed with PMR and GCA I started taking 60 mg of prednisone a day, and the shoulder problems cleared up immediately.

It could be your prednisone dose is too low, or maybe you have an injured rotator cuff?

Thanks Jeff@jeff97 for your response
I'm thinking the Prednisone is to low as it has no affects on me whatsoever or maybe I'm steroid resistant, I was just doing some reading on that subject. She did a physical examine on me and found nothing to support the torn rotator cuff. I'm going to give it another week and if nothing changes then I'll start to raise the flags. I'm just approaching the 3 week mark.
I've also heard that weather has a part in this, it's been a little cooler here lately with rain. I'm not a believer of this theory though.

@paul767 I was dx with PMR 12/24 and my shoulders is one of the regions where I have so much pain,by July of this year I had MRI of both my shoulders and I have SLAP tears both shoulders and bursitis as well … I am going for some PT and a cortisone shot soon , hopefully it helps , good luck 🍀

When I first saw a rheumatologist for PMR in 2021 he sent me for a DEXA bone scan and tested my vitamin D level. The D level was low so I took 1000 iu and upped it to 2000 when a second test showed it was still a little low. The DEXA showed osteopenia, less severe than osteoporosis, which I knew about. He thought I should take Fosamax because prednisone decreases bone density. I stayed on that 2 years, then got off. I also got regular about taking calcium. I appreciate that he was proactive about bone loss. My latest DEXA shows my bone density only slightly lower than it was 14 years ago.

When I first started on prednisone 2+ years ago, my D3 level was 49 (50+ is normal). That was while I was already taking one 1000IU D3 tablet a day. So I've taken 2 tablets a day since then. D3 blood test last week was 117, which is very good. I don't think it's affected my pain levels one way or another, but it helps the body absorb dietary calcium into bones, so good levels are essential for people our age, especially while on prednisone for any reason.

I have been treated for hypothyroidism for the past 21 years. That also lowers vitamin D levels, because the thyroid hormone helps the body absorb vitamin D. I checked with google, and it says people with PMR and GCA are more likely to have Hashimoto's hypothyroidism than other people, because Hashimoto's is another auto-immune disease. So in addition to having your vitamin D checked, also have your thyroid checked if you haven't already.

Vitamin D3 does more than promote bone density.
It is anti inflammatory and regulates immune function,
It decreases some of the cytokines that that are overactive in PMR. Rheumatologists need to check
our levels and be proactive in evaluating our increased
cardiovascular risks as well.

@linda7 if you focus on some strength building exercises this will help build bone strength health -
1. Weight Bearing Exercises like Walking, Running, Jogging, Dancing, Stair Climbing
2. Resistance Training like Bicep Curls, Squats, Lunges, Push-Ups
3. Balance Training like Tai Chi, Yoga, Single-Leg Stands

@jeff97 another big contributor to the national vitiman D deficiency problem is sunscreen. Vit D is the sunshine vitamin and sun screen prevents us from converting the sunshine on our skin to the vitamin D we need. Less skin cancer, more vit D deficiency.