bruised finger from prednisone ? | Arthritis Information

I wonder if anything like this has happened to anyone else here.

This is probably going to sound really strange, but this is what happened: I was pulling weeds in my yard about a month ago, nothing very strenuous, and all of a sudden I felt a "snap" in my right index finger. Then it turned all blue and purple and got a little swollen.   There is/was no external wound, and no broken bones; it's not infected. As it improved, the bruising was sort of wavy along the length of my finger.

Just when I thought it was healed, it happened again spontaneously; I was doing nothing, just maybe bent my finger and pop, it turned blue at the top joint and the entire finger got all blue/purple again. This time when it started getting better, it was numb part of the time.

Then it happened a third time; just turned blue spontaneously, and it feels numb part of the time. Even if my hands get cold, my other fingers don't feel numb, just this one!

My primary care doc and rheumatologist think it has to do with prednisone thinning the skin and that a capillary broke. It's just so strange that it's only happening in the right index finger!

I've been going for physical therapy, and my therapist recommended that I go see an orthopedist who specializes in the hands. I'm waiting to get a referral and make an appointment. I doubt he will be able to tell me much more than "it's caused by prednisone" but who knows.

P.S. just made the appointment, it's Aug 2

freesia
freesia2010-07-22 10:35:16Freesia,
Prednisone causes so many strange bruises on my body, that it wouldn't surprise me if this isn't the cause of your problem. I had oral surgery about 2 weeks ago to remove a bulging vein under my tongue. The oral surgeon thought it was a blocked duct, but my dentist had referred me to him because he suspected it was a blood vessel. My dentist was correct and thinks it was from the prednisone.

Have you noticed other bruising? Sometimes I even have burst vessels in the white of my eye which the opththamologist says is from the prednisone.   And my arms and legs also have bruising. Just playing with my daughters puppy lands me with pin prick sized bruises.

Anyway, hope this helps a bit and that you're doing better. How much prednisone are you on now? I'm only on 9 mg and thinking that I might need to increase it. My blood tests have been bad and even after 6 weeks on the last taper, things aren't improving. The bruising is one reason I'd love to reduce the prednisone, but it's not worth the pain. I'm "only" 61...

Jannie     I haven't noticed any unusual bruising yet but I'm sure it will show up some time. I'll be on the lookout and let you know. Sorry I couldn't be more help. Let us know what the hand doc has to say! Hi Jannie and russellcat,
Jannie--I'm sorry you are having this bruising---so scary and frustrating. That you are having problems of this sort confirms my suspicions about pred. I haven't noticed any other odd bruising on myself (yet), just this finger problem. How long have you been on pred ? That's scary about the vein in your mouth--did they actually remove it?

I'm trying to taper from 10 mg prednisone--I am trying my own version of the one recommended here (was it Ragnar the swede who used his own method of tapering by alternating the dose ? Not sure I have his name right). For a few days I took 9.5 mg, today I took 8.5 mg. I notice my shins are sore, and I took a 1-1/2 hour drive, after which I could hardly move my legs! My rheumy wants me to taper, because she is concerned about my bone density--I appreciate that, but I think she wants me to taper too quickly. Even doctors don't seem to understand the pain! Any time I've tried tapering, my blood tests have been bad. On 10 mg for a month, my numbers all looked great except my hemoglobin--it was low again--not sure what that's about. My doctors keep talking to me about taking meds for bone density, but I just can't go that route yet. Maybe I'm crazy?

You're 2 years younger than me.

russellcat, thanks--I'll definitely post the results of my doctor visit!

freesia
freesia2010-07-22 17:22:24Hi everybody!

I just want to emphasise something - yet again! It does seem to me that many of you are under the impression that having taken steroids for a while you can taper the dose down to a low enough level to stop taking them altogether. This is what happens if you have to take steroids for asthma or a severe chest infection and for some other short-lived ailments.

In the case of PMR the steroids ARE NOT CURING THE INFLAMMATION ACTIVITY. They are reducing the inflammation to a level where you can function as near normal as possible. The fatigue aspect of the PMR does not change markedly and that remains something that is individual to you and will vary.

There is no cure for PMR at present. You have to take this into consideration and decide whether you want to be an invalid until the PMR goes into remission on its own account or whether you will take steroids to make a reasonably normal and relatively pain-free life possible. Many doctors will still tell you that PMR will "burn itself out" in a couple of years. This is not true. Some patients may have it for a couple of years and then it goes into remission and they need no medication but it can return after a periods of months or years. Other people may find that they can get down to a very low dose of steroids (5mg per day or less) but cannot go below a certain dose without the pain and stiffness returning.

Anyone who has been started on steroids to control the symptoms should try to get the dose down to the lowest possible level and as quickly as possible. However, this does NOT mean 15mg a day this week, 10mg a day next week, and so on until you stop taking it after a couple of months. What is meant is that you take 15mg a day (this is the recommended starting dose and if it is PMR you should show a good response within a few days) for perhaps a month or maybe more until the pain and stiffness is at a minimum. Then you can try reducing the daily dose to 12.5mg. In the UK the prednisolone tablets come as 5 and 2.5mg enteric-coated pills which cause fewer stomach problems but cannot be cut and 1mg plain white tablets which can be cut. This makes it possible to make combinations of pills to go down 1mg or 2.5mg a day each step.

If you reduce from 15 to 12.5 this represents a 17% drop in dose which is quite big but also quite possible at this level and the next drop to 10mg should also pose few problems. However, once you have reached 10 mg per day you should aim for the drop to be as small as possible for various reasons. After a while your body has "forgotten" how to respond to the need for steroids and if the blood level falls below what is needed for all the body processes that it is involved in it won't automatically make some of its own and you suffer from the symptoms of "steroid withdrawal". This isn't addiction - it is just your body takes quite some time to relearn what it has to do and you have to look after it in the meantime.

To go down from 10mg you really should never reduce by more than 1 mg a day and make the transition from 10 to 9 slowly. So maybe take 10 on Monday, 9 on Tuesday, 10 on Wedesday and 9 on Thursday and so on for a few days. If you feel good at that try alternating the doses as 10/9/9/10/9/9/10 and so on. If that's still good drop to taking 9mg every day. Then stay at that for a few weeks and make sure that you are still comfortable. You may have a bit of discomfort for a week or so which is due to the steroid dose change but it will improve and should disappear in that time. If you find the pain comes back and gets steadily worse over the next few weeks that is much more likely to be because the PMR is not being suppressed by the new dose. In this case go back to the dose that did work - you might not need to go back to 10mg every day, maybe on alternate days.

Every time you would like to try reducing the dose you are on do something similar. But if the PMR pain returns - that is the dose at which you need to stick for some time before trying again to reduce. It may be that you find that you are OK at 7mg a day but at 6mg you have pain and stiffness and feel bad. The best thing to do at this level is to accept it - at these doses the side-effects are minimal for most people as this is similar to the level your body produces anyway to make it function properly. Some people think that one cause of PMR may be that the body is not making enough cortisol, the natural steroid, so the dose we need is just replacing it - like diabetics need insulin because their body doesn't make enough and the fact that PMR often starts after a stressful event or you get more symptoms in periods where you are being stressed in some way, either mentally or physically, would fit with this theory.

There is no merit in reducing the steroid dose to a level where the PMR symptoms return. If you are going to do that you might as well say from the start well, I'll just live with the pain. Taking a low dose of steroid just to say it's lower and I'm nearly able to stop altogether is pointless. You will have achieved nothing in the end. Some people do not lose bone density whilst taking steroids. Some people lose bone density even though they have never taken steroids. Once you are at about 7-10 mg a day the loss of bone density is minimal providing you give your body a chance: take calcium and vit D supplements so the raw materials are there, do body-weight-bearing exercise for at least 30 mins a day (brisk walking or jumping rope, something where the feet really strike the floor). Calcium should be taken in at least 2 separate doses, not within 2 to 3 hours of your steroid dose (they interfere with one another) and preferably one at night and with other food. Even a healthy young person loses a very very small amount of bone density overnight and taking some calcium just before bed helps this! So, steroids for breakfast, calcium for lunch and supper.

Inactivity is the worst cause of losing bone density - so if you think about it, not taking steroids may well mean you can't do anything but sit in a chair and read a book - someone has mentioned in another thread that that is about all she can do now she is at a very low dose of steroids. That too will make her lose bone density. So, are you any better off? No steroids but you can't do any exercise? Bone density can be monitored, it used to be called a dexa scan. But not everyone with osteoprosis breaks a leg anyway.

Each patient who is diagnosed with PMR has a choice to make: take steroids and live normally or don't take steroids and be an invalid and in pain most of the time. But don't allow a doctor to force you to take too low a dose to achieve relief or fall into the trap of believing it is virtuous not to take the medication that allows you to have a normal life just because you might get osteoprosis.

I hope what I have said here is helpful to someone even if it is quite long and if you have any questions - ask away. And freesia - doctors don't understand the pain as they've never had to suffer it. A rheumatoid arthritis sufferer with twisted hands and feet gets sympathy from most people, the ones where there is no joint deformation yet tend not to get that sympathy. And we with PMR look well, you can't see stiffness, pain in a joint and fatigue - and that fatigue isn't just being tired after a lot of work, it's there before you even get out of bed! It's still real!

MrsE

[QUOTE=MrsE]Hi everybody! [/QUOTE]Hi Freesia,
I posted elsewhere here, that after needless suffering (thanks for the great information, Mrs. E.), I finally called my rheumy. I was on 9 mg prednisone/day. She increased it to 15mg./day. I started this Friday and today, I'm beginning to feel so much better. I am choosing to take the prednisone at a higher dose and have my quality of life back. My bone density has been fine. I'll have another test in August, but so far the prednisone hasn't affected that. Mrs. E has a great point, bone density will most certainly worsen if all you can do is sit in a chair and read. Before PMR, I used to hike for miles.

Yes! The doctor did remove that thing bulging vein under my tongue. It was not a good time for me. I couldn't talk or eat for a week.

My rheumy says that I'm the only person on prednisone that she's treated that has lost weight. I try not to overdo it food-wise. I think that would depress me even more if I gained a bunch of weight as well. I do have the moon face though, and that is not a pretty sight. It is what it is, I guess. I'll put up with the bruising and the moon face as long as I can move and not be in pain.

I think you may be decreasing the prednisone too quickly. My rheumy as me decrease 1 mg. every other day for 2 weeks and then stay on the lower dose for 1 month before trying to taper again. It seems as if you have gone too low too quickly. Remember prednisone is not the enemy and stay at a dose that keeps you moving and enables you to enjoy life.

I enjoy our discussions and send you gentle hugs,

JannieFreesia,
Oops, I forgot to answer one of your questions. I've been on prednisone for 15 months. My PMR began in May, 2009 but I didn't get a diagnosis until July of 2009. I started at 40 mg. of prednisone by a GP who didn't know what was wrong with me. Finally saw a rheumatologist in July and started to taper the prednisone at that time. This isn't the first time that I've had to increase the dosage. This site is such blessing. There is no one that can understand what we are going through, unless they have felt it as well. We look so well, but the pain is real.
Jannie

Hi Jannie,
Thanks so much for your input!

You are inspiring me to get out and walk like I used to. I ride a stationary bike every day--I've been doing that for over 30 years now--but it isn't weight-bearing exercise like walking. I know I need to at least walk to help my bone density. Light weight lifting would be good, too.

I'm happy for your that the prednisone hasn't caused you to lose bone density! I had a bone density scan after about 3 months on pred (I was due for one) and it didn't show any appreciable difference, but I think it was too early to tell if pred is affecting me.

I'm glad you haven't gained weight on the steroids. I read that one symptom of PMR is losing weight without trying, and I did experience that. I expected to gain weight back from the steroids but that hasn't happened so far, maybe one or two pounds--knock wood it will continue. Of course, the highest dose I was on was 12.5 mg and only for about 3 days.

I think you are right about the tapering. I also read MrsE's post and I think her idea of alternating doses day by day until one is comfortable is the way to do it. I wonder why the docs don't seem to know this?

Thanks for reminding me of your history with PMR. I know I read it on other threads but it's hard to remember.

As far as looking well, but having such real pain: It's so true. I'm sure that it is baffling to "outsiders" to see us struggling to walk but not looking sick.

This site really is a blessing; I'm so glad I found it. The people here are wonderful, and they have been a great help .

I enjoy our discussions, too. freesia2010-07-25 10:26:50I am so glad I found this forum. I was laughing out loud at the steroids for breakfast and calcium for lunch and dinner!! Love it!! I actually was taking my pred pretty close to the calcium so maybe thats why I relapsed? As far as the skin issues I have had lot of bruising and even carrying plastic bags over my arm will cause blood blisters and skin tears just like I've seen on very elderly patients. Sad to see. One of my nurse coworkers gave me some cream Mary Kay satin something she says her mother who was steroid dep. for asthma swore by this cream to help prevent prednisone skin so I am trying it and wearing undercast material on my arms - my job is fairly physical and I'm not the most graceful! also thanks for the tapering advice hopefully at my appt next month I can start thinking about tapering. hope you all have a good week going to Cape Cod for a few days whoo hoo! Thanks, Parker, and all. Your input has been reassuring, although I hate hearing your suffering, of course.

I saw the orthopedist who specializes in hands and he, like my other doctors, was not sure what happened to my finger. By the time I had my appointment, it had basically returned to normal so he couldn't see the bruising and inflammation. However, his best guess was that I tore a sheath of skin (or muscle) that encircle ligaments in the finger. I'm not surprised that this injury is a mystery, since everything that happens to my body since I've had pmr seems to be a mystery! freesia2010-08-04 20:13:39

MrsE,

Thanks for the great information on pmr. I was diagnosed in April 22, 10. Never heard of

it and knew nothing about prednisone. The Rheumy. said very little so I have searched

the internet and thank goodness I ran across your information. I had come to the

conclusion, pred. may have side effects, but I do not want to be an invalid, not able to

walk or raise my arms. I am down to 10mg. some discomfort in the a.m. but hey I can

walk and raise my arms........Are you familiar with gca? I am having to keep pulse in

temples checked, Dr. said that can come with pmr. Hope not!!!! Your right the fatigue

is always there.

I am trying to stay off sugar and high glyc. carbs. also looking for an anti-inflammatiory

diet to possibly help. I need to research info. on the immune system, since mine is

suppressed with pred. How long have you had pmr? are you in remission? Thanks

again, the information was most helpful.

KaCee

Hi KaCee,

MrsUK who also posts on here is your GCA expert! But not everyone who has PMR goes on to develop it. Just go to the doc if you get any headache, sore scalp, jaw pain, visual symptoms - let him decide if it is something to worry about. Better to go too often than not when it matters. If you develop temporal arteriitis you can go blind without treatment, which is basically much higher steroid doses to deal with the inflammation.

Have you looked at the UK patient experience website for PMR? MrsO who posts there is a fund of knowledge about anitiinflammatory foods. I'm lucky - I've had less infections since I've been on steroids than before!!

I've had PMR for at least about 5 or 6 years now - only been on steroids for just over a year as it wasn't recognised despite my complaining to various docs. I still have it, I need steroids but on 17.5mg taken every second day (alternate day therapy, an option sometimes below 10mg per day, double the dose so one day on, one day off, fewer side-effects) I ski 3 or 4 times a week in the winter, 2 days ago went for a longish walk up the mountain (at 2250m, took the lift up!) and have been fine.

all the best, MrsE

Mrs. E,

I have not checked the web site in a while, trying to get my plants inside for winter.

Thanks so much for your reply, I went back to the Rheumy, and told him about

the aching in my left temple and I could not find a pulse on left side, he just felt and

said nothing so I guess he did not think it was gca, he did say not to reduce

pred. and stay on 10 mg. 6 more weeks. He only goes by the sed rate, it had only

gone up from 26 to 29, my normal before this was 15, was 97 when I was diagnosed

with pmr. I will always wonder what caused this. I know pred. is not good for you, but

I was bed fast, could not even turn over, totally an invalid, After starting pred, 15 mg. by

the third day I was able to turn over and get up... Wow,,,what a time,,,

I can't wait until I can swing my golf clubs with out pain in upper arms. The skiing sounds

very encouraging and fun. I have been walking more, like if I push one day, I am exhausted the next. I am a Realtor and I try go to office for 3 hrs, 2 days a week. I

stay so tired. With pmr, you look normal so people seem to think,,,why does she

not look sick?? If they only knew. Not complaining, I am so thankful to be out of bed

and having a half normal life. It's amazing.

Could you explain the alternate doseage. Also, have you heard of the drug that

reduces inflammation, called pentoxifylline, or PTX, suppose to suppress the cytokines

that cause inflam. I like this web site, it has helped me so much, since my Rheumy

is a man of few words...lol

Will go and try to find the web site on inflam.

Take care, and have a Blessed Day.

KaCee