I'm taking steroids for polymyalgia rheumatica (PMR) – does this mean I can't have surgery for my arthritis?
Q) For several years, I've suffered a gradually deteriorating right hip due to conventional arthritis. In April this year I decided that I'd face up to the operation and made arrangements accordingly. However before this could be carried out, I was struck down by polymyalgia rheumatica (PMR). Treatment followed successfully with steroids (30 mg reducing down to maintenance dose for the next 12–18 months). My surgeon is now saying he'll operate if pressed, but it's not a good idea while taking steroids. My GP says the PMR will return if I stop taking the steroids (currently 25 mg/day). What do you and any other sufferers who experience this dilemma think?
G R Ketley, Hertfordshire (Autumn 2009)
A) You've been unlucky to develop two rheumatic conditions. It's not clear how long you've had PMR but I'd expect that after your symptoms have been controlled by the steroids that a gradual but progressive reduction in dose will be made, aiming to get it down to about 5–7.5 mg daily. At this dose there's little risk to you having the operation, although certain precautions should be taken at the time of the surgery. Your surgeon will be worried about two things – your ability to heal after the operation and the chance of infection in the new hip. At the dose of steroids I've suggested I don’t think there will be any great problem with the healing. However, there's probably a very slightly increased risk of infection. Your surgeon may want to counteract this by giving you antibiotics at the time of the operation and for a short while afterwards.