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Question about PMR in addition to other autoimmune disorders?
Polymyalgia Rheumatica (PMR) | Last Active: Jun 3 2:12pm | Replies (32)Comment receiving replies
Enthesitis & PMR
In 2021, I began a vigorous but sensible walking program to counteract Covid related weight gain and inactivity. It was very successful emotionally and physically and I continued to enjoy walking 2-3 miles, 4-5 times a week with one 5-6 mile walk added many weeks. Based on my age, 75, bone density testing of osteoporotic, and a broken wrist from a fall during one of my walks, I began treatment with Fosamax in July 2022. I began to experience almost constant aches and pains in my legs, not debilitating but definitely more than just annoying. I attributed this to a side effect of Fosamax use. I decided on a “drug holiday” from Fosamax in July 2023. There was no improvement in the leg aches and pains so Fosamax was not the cause. Overuse is listed as one cause of enthesitis?
In April 2023, I experienced Achilles tendonitis in one leg which did prevent my walking activities. However, I recovered with only chiropractic care. The aches and pains in my legs continued and I described them this way, “it feels like my muscles/tendons or ligaments are coming away from the bone, like really bad shin splints”. I thought I needed more and better stretching. I now think this was actually enthetitis, cause being my continued walking?
By October 2023, I was experiencing PMR symptoms. I was diagnosed with PMR in January 2024 and am now being treated, 20 mg of Prednisone daily for 90 days, decreasing over next six months. I am functional although very stiff and achy.
Does my experience sound familiar to anyone else?
Is my treatment comprehensive and appropriate if I have both PMR and Enthesitis?
Replies to "Enthesitis & PMR In 2021, I began a vigorous but sensible walking program to counteract Covid..."
"I began to experience almost constant aches and pains in my legs, not debilitating but definitely more than just annoying." “it feels like my muscles/tendons or ligaments are coming away from the bone, like really bad shin splints”. -- >>Hello @slf202mcinfo>> does this mean the pain is in the front of your calves ?
- I have been experiencing a searing pain very deep in my lateral right thigh. The onset coinciding with my PMR( ever since last spring) , so notably it is persisting throughout Prednisone dose as high as 30 mg until now ( tapered down to 3 mg/day) . My questions for you, if you don't mind, are 1) have you had any imaging done ? 2) can a pysiatiatrist or physical doctor /therapist "provoke' the pain by moving your leg around ? I saw my pysiatrist yesterday - that her is conclusion that the pain cannot be provoked , MRI imaging done in Nov. showed bursitis at top of femur- the pain is quite severe if she pushes on the area where the bursae is. I am trying to strengthen the gluteus medius.
20 mg of Prednisone daily for 90 days, decreasing over next six months>>> this regime of prednisone seems different from others on this forum who have described their schedules, i seem to recall a general step-down that quickly gets you to 10 mg/day , and then it will occur (much) more slowly*. -- Have you decreased your Prednisone dose yet ? How are you feeling today ? : )
* see attached table 3
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Have you talked to your rheumatologist about your tendon pain? That’s not usually associated with PMR, but it’s not to say you can’t have PMR and another autoimmune condition, or have PMR with a regular tendon injury.
Enthesitis (inflammation of the tendon) can either be just that—usually an overuse injury, or it can be a symptom of many different autoimmune arthropathies.
It might be worth talking to your rheumatologist about it to rule out if it could be related to another condition. But it’s hard to tell because Achilles tendon injuries take a long time to heal. Even if it gets better, the tendon tissue tends to heal in a disorganized manner, which can cause pain to linger. There are specific exercises meant to realign the tissue.
(I know this because I have chronic tendinopthies related to an autoimmune arthritis and even after I got treatment it took a long time in PT).
The exercise prescribed for Achilles tendinopathy is eccentric heel drops: https://www.sportsinjuryclinic.net/sport-injuries/ankle-pain/achilles-pain/achilles-tendonitis-exercises#:~:text=Begin%20standing%20with%20one%20foot,every%20day%20for%2012%20weeks.
But the exercise is done differently if the pain is at the insertion point at the back of the heel only.
Hope that helps?