Doc: All anti-inflammatories are not alike
Dear Dr. Roach: I’m a 62-year-old male in generally good physical and mental health. I was diagnosed with Crohn’s disease at age 21. I had bowel resection surgery, but have no debilitating symptoms now, except some diarrhea flare-ups.
My question is regarding polymyalgia rheumatica. I was diagnosed with this just two weeks ago. I’ve been on 10 mg of prednisone since, which has helped a lot, but I still have stiffness and very minor pain most mornings. My symptoms started about two months ago, relatively suddenly, first in one hip and then it spread to both hips and both shoulders. A dozen 200-mg ibuprofen didn’t help during the day, until I saw my doctor.
Could this be related or connected to my Crohn’s, since they both are inflammatory conditions? Is there another treatment option besides prednisone? How long might I have to take it? How might it affect my Crohn’s, or my high blood pressure? What can cause or trigger PMR? Why not get cortisone injections? If prednisone is an anti-inflammatory, and so is ibuprofen, why isn’t ibuprofen effective? Lastly, does long-term prednisone use greatly increase my risk of other illnesses or infections?
Dear J.O.H.: That’s a lot of questions.
The cause of PMR is not known, and no trigger has been identified. People with certain HLA subtypes (there are many human leukocyte antigen subtypes — they are proteins on white blood cells) are at high risk for PMR, and others put people at high risk for Crohn’s disease. The combination of the two is unusual.
Yours is not a classic case of PMR, which usually is much worse in the upper arms and shoulders than in the hips, much worse in the morning and dramatically improves with low-dose prednisone (10-20 mg). Although ibuprofen does relieve some kinds of inflammation, it’s in the class of nonsteroidal anti-inflammatory drugs, which is ineffective in PMR. Prednisone, a glucocorticoid steroid, is a much more potent anti-inflammatory. A blood test, the ESR, almost always is high in people with PMR.
Although prednisone dramatically improves PMR, it needs to be taken for one to two years (sometimes longer) in most people and can cause many side effects. Steroid shots are usually not practical since many joints are affected.
High blood pressure and diabetes are common with oral or injection steroids. Reduced bone strength is so common that many experts start medication to prevent it in people at risk. Infection risk is also increased, so it’s wise to make sure your immunizations are up to date, to take ANY sign of infection seriously and to see your doctor promptly.
Dear Dr. Roach: For several years, I had a terrible cough from fall to spring, and practically lived on cough drops. Two different doctors diagnosed me with acid reflux, despite the fact that I had no symptoms. Nexium didn’t help. I finally saw an ENT doctor, who asked what the humidity was in our house. My husband said about 35. The doctor told us to crank it up to 60-75, and in four days my cough was gone with no medications. So now, come fall, I have a humidifier until spring, with no cough and no cough drops.
Dear R.G.: Dry air can irritate the upper airway from the sinuses to the lungs, and can cause a cough. I’m publishing your letter as a reminder of this and to possibly save someone else the years of discomfort you experienced. There are many causes of chronic cough.
Email questions to ToYourGoodHealth@med.cornell.edu.