Rheumatoid Drs

Posted by bren0718 @bren0718, Mar 8 10:08am

I was diagnosed with PMR in August of 2023. My family doctor has been all I have seen about my disease. I was ok with her until I came on this support group and now realize I dont know much about the disease itself or about tapering off of the prednisone. In December I was diagnosed with severe osteoporosis. My Dr told me to start tapering off quicker . I have gone from 20 mg to 7.5 . She never told me at what rate to taper or that if I was having a hard time I could go back up for a bit and then try again. I think I need to see a specialist after seeing all your comments. I have only had blood work done the one time and don’t understand the numbers that people are posting. I feel I have done myself a disservice by not seeing a specialist. Do any of you just have your family physician treat you ?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@dadcue

Knees, shoulders, hips and ankles are all "large joints and typically aren't the presenting signs of RA. My impression of RA is disfigured hands.
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
"Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body."

The way you describe the onset of symptoms sounds eerily like reactive arthritis to me. You don't have to be aware of any infection to have reactive arthritis. Often the infection is long gone by the time symptoms of reactive arthritis begin.

Were you ever tested for HLA-B27? A positive result would not be definitive of anything but it might be useful information.
https://www.ncbi.nlm.nih.gov/books/NBK551523/
You only need to have the HLA-B27 test once. I don't think doctors like to request this test because it is probably expensive. Also, there isn't anything they can do about it if your HLA-B27 is positive. Being HLA-B27 positive won't prevent you from being diagnosed with something else like RA or PMR later on.

PMR is more of a syndrome rather than an exact diagnosis. My understanding of PMR is that it is more of a conglomeration of many things which isn't well defined. I think doctors call things PMR and throw Prednisone at the problem. When people have a rapid response to prednisone it is like confirmation of PMR. However, a rapid response to Prednisone doesn't confirm anything either.

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You mentioned disfigured hands. When o started with this doc he asked me what my treatment objective was - and I told him I don’t want gnarly hands.

I’ve had 3 surgeries to release trigger fingers and am seeing the hand surgeon tomorrow to setup for release of dupuytren contracture. I’m working hard to avoid gnarley hands 🙂

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@bren0718

I am taking the Evenity shots once a month for the osteoporosis. I can take them for12 months. I have not heard of Kevzara. I’m going g to look into and see if maybe this is something I can take. I know I need to get off the prednisone as soon as possible but being able to function take priority. I went up .5 mg yesterday and today and I feel so much better . Will wait a few days then go back down. I feel like I need to do the physical to help with the osteoporosis.

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Kevzara (Sarilumab) is the only biologic that is FDA approved for PMR.
https://www.nejm.org/doi/full/10.1056/NEJMoa2303452
Biologic treatment for PMR is available in the United States.

For our British friends:
https://ard.bmj.com/content/81/Suppl_1/210.1

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@dadcue

Knees, shoulders, hips and ankles are all "large joints and typically aren't the presenting signs of RA. My impression of RA is disfigured hands.
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
"Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body."

The way you describe the onset of symptoms sounds eerily like reactive arthritis to me. You don't have to be aware of any infection to have reactive arthritis. Often the infection is long gone by the time symptoms of reactive arthritis begin.

Were you ever tested for HLA-B27? A positive result would not be definitive of anything but it might be useful information.
https://www.ncbi.nlm.nih.gov/books/NBK551523/
You only need to have the HLA-B27 test once. I don't think doctors like to request this test because it is probably expensive. Also, there isn't anything they can do about it if your HLA-B27 is positive. Being HLA-B27 positive won't prevent you from being diagnosed with something else like RA or PMR later on.

PMR is more of a syndrome rather than an exact diagnosis. My understanding of PMR is that it is more of a conglomeration of many things which isn't well defined. I think doctors call things PMR and throw Prednisone at the problem. When people have a rapid response to prednisone it is like confirmation of PMR. However, a rapid response to Prednisone doesn't confirm anything either.

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So my blood work showed negative for PMR but my symptoms were spot on for it. I have neck and shoulder pain plus hips glutes thighs. It came on slowly in my hips and thighs but I have been hurting for a while in my neck and shoulders. I just thought it was from being a hairdresser for 40 years.morning are the worst and then by mid day I’m feeling a little better. My Dr said that since I was just finishing a taper pack of prednisone that it may have given me a false negative. That is one more reason I need a specialist. She has never recommended doing anymore blood work. Now I’m second guessing my diagnoses even though I really do have every symptom of PMR

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@bren0718

So my blood work showed negative for PMR but my symptoms were spot on for it. I have neck and shoulder pain plus hips glutes thighs. It came on slowly in my hips and thighs but I have been hurting for a while in my neck and shoulders. I just thought it was from being a hairdresser for 40 years.morning are the worst and then by mid day I’m feeling a little better. My Dr said that since I was just finishing a taper pack of prednisone that it may have given me a false negative. That is one more reason I need a specialist. She has never recommended doing anymore blood work. Now I’m second guessing my diagnoses even though I really do have every symptom of PMR

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Oh snap. You need a rheumatologist. Badly.

What town do you live in?

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@pb50

You mentioned disfigured hands. When o started with this doc he asked me what my treatment objective was - and I told him I don’t want gnarly hands.

I’ve had 3 surgeries to release trigger fingers and am seeing the hand surgeon tomorrow to setup for release of dupuytren contracture. I’m working hard to avoid gnarley hands 🙂

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Trigger fingers occurred frequently to me too. I don't think I have RA although some fingers are a bit crooked. I haven't needed any surgery to release the many trigger fingers. However, I would go to orthopedic surgeons where I worked and they would release the trigger fingers for me on the spot. I got some strange looks from those surgeons when I would randomly go to the orthopedic surgery inpatient unit to see if anyone could help me ... I wasn't too shy because I needed to go back to work too.

I went to the same orthopedic inpatient unit during work when my thumb went limp. I asked a surgeon if he knew what was wrong with my thumb. He asked me if I was the one with the trigger fingers. The surgeon said I would need a hand surgeon soon because the tendon attaching my thumb had ruptured.

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I can relax mine with massaging the path of the tendon and get it straight when it is clawed. But it doesn’t last. I usually start with getting the proximal joint injected with a steroid where the tendon hits the finger. That lasted about 7-8 weeks this time. Early on in my disease I had one on my left hand and it was injected and never bothered me again. That never happens now.

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What’s the fix for ruptured tendon?

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@pb50

My ace Rheumy in NYC told me when she took my history that my first introduction to joint pain that I had recounted as gout was very likely to have been my first symptom of RA. My current Rheumy recognized that when I have flares always involves large joints - Sometimes exclusively so. So I don’t know what to think. I told you I think that my son had reactive following knee surgery and went from a 22 yo to a 82 yo man overnight. We took him to a Medical College hospital where they actually had a unit for post surgical event management and immediately said “reactive arthritis”’. But once they cooled his down it never bothered him again - I mean he is just a skeletal mess but not from arthritis.

Does reactive arthritis respond to Remicade? Because except for this infrequent Flares I’m pretty well controlled.

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Nothing is FDA approved for reactive arthritis because of a lack of research. Reactive arthritis is rare in the realm of spondyloartrtitis which collectively is more common than RA. Indications for Remacade are the following:

REMICADE® is a prescription medication used to treat:

Crohn's Disease
Pediatric Crohn's Disease
Ulcerative Colitis
Pediatric Ulcerative Colitis
Rheumatoid Arthritis
Psoriatic Arthritis
Ankylosing Spondylitis
Plaque Psoriasis

With the exception of RA, all of these conditions are part of the spondyloarthritis family.
https://www.arthritis.org/diseases/spondyloarthritis

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@dadcue

Nothing is FDA approved for reactive arthritis because of a lack of research. Reactive arthritis is rare in the realm of spondyloartrtitis which collectively is more common than RA. Indications for Remacade are the following:

REMICADE® is a prescription medication used to treat:

Crohn's Disease
Pediatric Crohn's Disease
Ulcerative Colitis
Pediatric Ulcerative Colitis
Rheumatoid Arthritis
Psoriatic Arthritis
Ankylosing Spondylitis
Plaque Psoriasis

With the exception of RA, all of these conditions are part of the spondyloarthritis family.
https://www.arthritis.org/diseases/spondyloarthritis

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As I recall - and it’s been a hot minute - they gave my son some
Kind of IV delivery in hospital for
3-4 Days and then sent him home With a 5 Or 6 day blister pack.

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@pb50

What’s the fix for ruptured tendon?

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My hand surgeon said it would depend if the ends of the tendon could be found and sewn together again. One end might have recoiled back into my arm. After surgery the surgeon said he found the ends of my ruptured tendon except they were too frayed to be sewn together. For that case, the index finger has two tendons attached. The index finger can still work with one tendon.

My surgeon said he cut one tendon to my index finger and moved it over and reattached it to my thumb. It felt weird after surgery but I'm used to it now.

Surgical treatment is to either place a piece of tendon, taken from elsewhere, between the two ends (Tendon graft) or to take another tendon in the hand and move it to take over the function of the ruptured tendon (Tendon Transfer).

The tendon most often used as a transfer is one of the two extensor tendons to the index finger.

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