New PMR patient, wondering if mornings will become pain free someday

Posted by tedmbrady @tedmbrady, Sep 3, 2023

I am 69, fairly active, avid golfer, etc. After dealing with hip, hamstring and especially shoulder pain and extreme soreness I had my CRP measured a little more than a month ago (23.8) and was fairly quickly diagnosed by my GP as having PMR. I started with 15mg prednisone and after a week went to 20mg. This dosage allows me to play golf and be pain free (mostly) by midday. They referred me to a Rheumatologist whom I see on the 19th for the first time. I have a second blood test this Tuesday (5th).

Question: can I anticipate ever being pain free first thing in the morning (only shoulders hurt, but pain is not inconsequential)? Or is this an indication that maybe 20mgs is not yet enough? I realize I'm only 4-6 weeks into this, but other threads suggest the prednisone should be able to wipe this out for now (I realize it is with me forever and might rear its head in months or years, but hoping this first episode finally goes away for awhile).
Thx
Ted

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@trimomlewis

I was diagnosed in November 2022. My “flares” start, and are worse in my hands. I can tell when starting as my fingers swell. Do you have swelling of your hands?

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I am grateful that I do not have swelling in my hands and fingers. I have been diagnosed with osteoarthritis in my fingers. I suppose most of my pain is in my fingers, a combination of the osteoarthritis and the PMR. Stiffness is probably the most debilitating factor. It is persistent, regardless of my prednisone dose.
Best wishes and blessings.

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@tedmbrady

Thanks soo much for the nice comments and reassurances (where there can be).

I may try the 2/3 and 1/3 split for an experiment of sorts, especially on non-golf days 🙂 I don't have trouble sleeping (yet) and only have the shoulder pain in bed for like the last hour or so (5:30-6:30am-ish). But then it persists until at least 90 min-2 hr after eating and 20mg (4 x 5mg) prednisone. Mid morning golf is in my short term goals, but I'm not rotating the shoulders (at least easier than raising them or deflecting them down) pain free until before noon! Maybe twilight golf is in my, er, twilight years plan.

I'm here to soak up some PMR knowledge, get through this as well as possible, and maybe help with other brand new sufferers...assuming I learn anything from my journey. 🙂 Thanks

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I was diagnosed in June on this year. I am also very active working out every day. I was either lifting weights, walking 6 miles, swimming, working in the yard, etc. I started on 20 mg of prednisone for the first 2 months. My rheumatologist then reduced it to 15, which caused the pain to intensify so she bumped me up to 17.5. That seemed to be ok but the mornings are tough. There are some mornings I actually need a walker to get to the bathroom. Gentle stretches and walking seem to help the most. After 2 weeks of the 17.5 (now on 3 months of taking prednisone), I am back down to 15 but split the dose by taking 10 in the morning and 5 in the afternoon. I will see how that does. I agree, doing anything strenuous in the morning is not a good thing. My Rheum and my PT keep saying less is more with this condition, and that is a very difficult thing to accept and adhere to for some of us. As difficult as it is, I am learning to cut back. Afternoons are definitely more conducive to more strenuous activities (the "new" strenuous for us:-)). The difficulty I am having is I am dealing with RA, osteoarthirtis, bulging and compressed discs so it is trying to figure out what I can do without setting off a reaction to one of the other things.

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@sunshine4u

I was diagnosed in June on this year. I am also very active working out every day. I was either lifting weights, walking 6 miles, swimming, working in the yard, etc. I started on 20 mg of prednisone for the first 2 months. My rheumatologist then reduced it to 15, which caused the pain to intensify so she bumped me up to 17.5. That seemed to be ok but the mornings are tough. There are some mornings I actually need a walker to get to the bathroom. Gentle stretches and walking seem to help the most. After 2 weeks of the 17.5 (now on 3 months of taking prednisone), I am back down to 15 but split the dose by taking 10 in the morning and 5 in the afternoon. I will see how that does. I agree, doing anything strenuous in the morning is not a good thing. My Rheum and my PT keep saying less is more with this condition, and that is a very difficult thing to accept and adhere to for some of us. As difficult as it is, I am learning to cut back. Afternoons are definitely more conducive to more strenuous activities (the "new" strenuous for us:-)). The difficulty I am having is I am dealing with RA, osteoarthirtis, bulging and compressed discs so it is trying to figure out what I can do without setting off a reaction to one of the other things.

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I am also 69.

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@froehlich22

Hi Ted, I’m sorry you are now part of this “special” group. Since being diagnosed over a year ago, unfortunately, I have never obtained pain free mornings. In fact, it is rare that I am ever pain free. I currently am down to 9 mg Prednisone and take 17.5mg of Methotrexate. I, too, was very active before being diagnosed with PMR. I pray it someday goes away!

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Yes, I have a feeling painfree is a thing of the past. Minimizing is what I am shooting for and trying to figure out what I can do without having the pain increase.

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@megz

Calcium supplements can be problematic for some people, potentially causing kidney problems and artery calcification. Best to increase dietary calcium intake instead and take vitamin D3. I also take vitamin K2 which directs calcium to bones and directs calcium out of arteries. Vitamin D is best split into two doses a day to aid absorption, and taken with a meal that includes oil or fat as it is fat soluble. I take two 1000 IU vitamin D3 every day and a K2 (180mg) every second day.

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I could not take calcium pills so my doctor said to drink 2 glasses of unsweetened almond mile a day (30 calories and 470 mg of calcium a cup) along with yogurt that is high in calcium but low in sugar. I also take calcium chews. I also take two 1000 mg of Vit D3 a day with food.

Not sure what everyone else considers long term for prednisone, but I am getting the easy bruising and breaking of skin also. Have not considered methatraxate. Is that in place of prednisone or in addition to but with a decreased dosage of prednisone?

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@priscillat

I take my prednisone at 2:00/2:30 with a piece of cheese; when I wake up at 7:00, there’s no pain - just some stiffness.

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Is that AM or PM?

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@lizward46

Hi, Just to add to the confusion. When I was diagnosed in May 2023 I started with 20mg of prednisone. After a few days I reported to my rheumatologist that I wasn’t experiencing the “miracle pain relief” that she had said would happen. She then upped my prednisone to 30mg and BINGO I was pain free. I have continued to be without pain during several months of tapering. Am now down to 8mg. No side effects so far from prednisone (that I can observe). Also taking calcium, vit D, vit K, Pepcid, and fozamax, plustrying to keep to an anti inflammatory diet. My goal is to get off the prednisone without any flares. Right now I am tapering 1mg per month so it will be some time in 2024 that I will reach this goal. You mentioned that you will be seeing a rheumatologist soon. Hopefully you can get answers to all your concerns. Good Luck, be patient. Liz Ward

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How long were you on 30 mg and how many months did it take for you to get down to 8mg? How did you taper it and when you tapered it, how long did you take the lower dose before you lowered it again? Sorry for all the questions and I know everyone is different but I would sure like to be able to get by with a lesser dose also.
The other question I have is when the pain intensifies, is it doing more damage to the joints?

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In reply to @sunshine4u "Is that AM or PM?" + (show)
@sunshine4u

Is that AM or PM?

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Whoops. That’s am. 😊

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@tedmbrady

Thanks soo much for the nice comments and reassurances (where there can be).

I may try the 2/3 and 1/3 split for an experiment of sorts, especially on non-golf days 🙂 I don't have trouble sleeping (yet) and only have the shoulder pain in bed for like the last hour or so (5:30-6:30am-ish). But then it persists until at least 90 min-2 hr after eating and 20mg (4 x 5mg) prednisone. Mid morning golf is in my short term goals, but I'm not rotating the shoulders (at least easier than raising them or deflecting them down) pain free until before noon! Maybe twilight golf is in my, er, twilight years plan.

I'm here to soak up some PMR knowledge, get through this as well as possible, and maybe help with other brand new sufferers...assuming I learn anything from my journey. 🙂 Thanks

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So I have been splitting my 20mg prednisone to 15 at breakfast and 5 at dinner. The good news:
* daytime pain level is 0-1 still (mornings can be a 5), i.e unaffected
* I seem to be less jittery during the day
* I sleep ok (see below) and have a little less pain upon waking (3 is the average)

The bad news:
* I've been waking up at 5am and having a little problem falling back to sleep for my typical 6:30 awakening. Wondering if taking pill no. 4 earlier or later than dinner would affect this.

So, net/net is that I am quite a lot of the time pain-free, and will keep on the 3/1 split until I see the refered rheumatologist next Tuesday (first visit with him).

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@tedmbrady

So I have been splitting my 20mg prednisone to 15 at breakfast and 5 at dinner. The good news:
* daytime pain level is 0-1 still (mornings can be a 5), i.e unaffected
* I seem to be less jittery during the day
* I sleep ok (see below) and have a little less pain upon waking (3 is the average)

The bad news:
* I've been waking up at 5am and having a little problem falling back to sleep for my typical 6:30 awakening. Wondering if taking pill no. 4 earlier or later than dinner would affect this.

So, net/net is that I am quite a lot of the time pain-free, and will keep on the 3/1 split until I see the refered rheumatologist next Tuesday (first visit with him).

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That's mostly good news. When I took the second smaller dose at 4.30pm I slept okay and had fairly painfree mornings. Since moving the dose later to 7pm with dinner, (more convenient and more easily remembered), I'm waking hours earlier and had thought of moving that dose back an hour or two, or increasing the 1mg of night time Melatonin back up to 2mg.

Your experience tells me it is more likely the prednisone is causing my sleep changes rather than the Melatonin reduction. Thank you for sharing your experience.

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