It’s interesting. Well I think it’s interesting, anyway. Our members in the UK often mention being given steroid shots, especially when first diagnosed. It almost seems like the first thing they do after they’ve told you it’s PsA – drop your drawers! Our North American friends either don’t get them, or don’t talk about it.
Why does there seem to be such a difference in protocol? Or am I imagining a pattern that isn’t there?
I have never had a steroid administered that way except into a joint or bursa. I have been given oral steroids but choose not to do that anymore. I am in the USA. And yes people still ask me if Vermont is in the US when I travel! To funny.
I think you're right, intra-muscular steroid shots in the butt - especially as the first line treatment from the rheumatologist - seems to be the way they go pretty frequently in the UK. I remember my first one the day I was diagnosed, I was like a rat on crack for two days but that was it, no relief thereafter. The second (more in hope than expectation by that point) was a 'patch' between other treatments and didn't even register.
I've had oral steroids too, they got the no-response from my body either. Also I've had three shots into joints, they didn't help and it was only a depo-medrone/lignocaine combination used to irrigate my right shoulder sub-acromial bursa that provided much needed relief. Oddly enough I'm now written up as non-steroid responsive!
I think we have a bit of a thing about bottoms here in the UK, just think Benny Hill.
I've had 3. One did not noticeably work, one (the first) was pretty good and one (the latest) was awesome and lasted for months. So going by that I wonder whether they use different types of steroid and different quantities and if so, how do they judge which type to give and how much?
They're a good thing as far as I can tell. Perfect interim measure given how long the DMARDs take to work.
I’ve met one North American PsA-er who has had something called Kenalog. Nobody’s ever offered me anything like that. Bummer.
I bet your top notch hospital could provide some answers, there must be a reason for the difference in protocols. Perhaps if you ask nicely they'll provide a steroid shot too!
Seenie said:
I've met one North American PsA-er who has had something called Kenalog. Nobody's ever offered me anything like that. Bummer.
I'm not sure those steroid shots are good for you! IDK where I heard it, but I thought steroids can cause flare-ups of psoriasis. Maybe that was something else.
Well, Seenie here’s a good one for the record book. The only steroid shot I received in the bum was about 15 years ago in the ER. My hands and feet were wollen and it hurt to breath heavy because my ribs would hurt. I had never had this happen barely make a fist so in the middle of the night drove myself in. They said and I quote “we think you had an allergic reaction to the peperoni you ate.” I should mention my bp was pretty low as well but as an average American I ate peperoni pizza about once a week. Lol, sure they never heard of PSA but neither had I and since have avoided peperoni as the plague until my GP mentioned the connection recently when asking about my allery list. Since then I have only had injections in my toe joints and predisone in pill form. This story could probably double in a misdiagnosis discussion but I know you would find it funny.
Yep I've had a depomedrone shot in the bum twice. The first time I felt like a person for about two weeks before it wore off. The second time it didn't last that long. It's a tease but it's nice to feel normal for a bit.
I've also had one directly into the hip.
Yep, i am a scot in england, but despite that ( ;-) ) when I first saw rheumatologist he offered me a steroid shot to tide me over a few weeks until mtx could kick in, and it took a week to work, and lasted about six, it was so so good to sleep, to see the bones in my feet, to feel the fog slowly lift.... You can't have them often, but I was so grateful for those few weeks. And now it's gone, I'm no where near as sick as I was before I had it, though a long way to go.
I've had two long acting Betamethazone/Kenalog (long acting steroid/long acting anesthetic) injections into my right hip joint. Miracle dang drugs.
I've had regular steroid injections (Dex) into my left shoulder once (should have just eaten some M&Ms for all the help I got), right hip once (helped) and right arm once (helped).
When I was having bronchitis twice a year, sometimes I would get a shot of steroid, which nearly immediately helped me breathe better and a dosepak, which helped. What's really strange is since I was diagnosed and started meds, I've had bronchitis once (but it was a doozy). I've probably jinxed myself.
Mostly, though, I get prescribed a Dosepak if I'm in a flare.
I think we are more likely to be offered intramuscular for systemic inflammation in UK for systemic disease. Possibly when inflammation is suppressed and flares localise they give direct to affected joints. I had a steroid injection in my left shoulder years and years ago following a work injury, so depends on whether one affected joint or systemic flare here. IM steroids appear to have less side effects such as moon face and mood changes than oral, possibly that's why our docs prefer them?
sixcatlawyer said:
I've had two long acting Betamethazone/Kenalog (long acting steroid/long acting anesthetic) injections into my right hip joint. Miracle dang drugs.
I've had regular steroid injections (Dex) into my left shoulder once (should have just eaten some M&Ms for all the help I got), right hip once (helped) and right arm once (helped).
When I was having bronchitis twice a year, sometimes I would get a shot of steroid, which nearly immediately helped me breathe better and a dosepak, which helped. What's really strange is since I was diagnosed and started meds, I've had bronchitis once (but it was a doozy). I've probably jinxed myself.
Mostly, though, I get prescribed a Dosepak if I'm in a flare.
Well that is certainly in their favour! But I wonder why they don't use them much here.
C
Celtica said:
IM steroids appear to have less side effects such as moon face and mood changes than oral, possibly that's why our docs prefer them?
It looks like the use of steroid shots is officially frowned upon in the UK and that to some extent they, and oral steroids, are used 'covertly' due to the fact that they plug a gap and meet some objectives that cannot be met any other way:
Interesting article which explains it very clearly!
I lived in England when I was first diagnosed. My rheumatologist was a very nice guy but got a few things wrong. “It is a virus and it will go away in 18 months” and my very favorite " don’t trust your doctor get a second opinion". 2 appointments and I had PsA. So MTX and sulfasalazine were diagnosed and steroid shots in my knees, once. nOw I had immediate relief from the shots. I felt like there had been a mistake and I was actually fine! PSA will not go away.