PMR target areas

Interesting question @patricianolson. I've had PMR flare ups twice and I have degenerative arthritis in my spine and joints along with a TKR for my right knee. I had the TKR following my last occurrence of PMR but the problem with the knee started when I tore the cartilage and had surgery to remove it in my younger days before my health problems started. My personal gut feeling is that they are not related but then I'm not a medical expert. There is another discussion where a similar question was asked.
-- PMR and preexisting knee pain: https://connect.mayoclinic.org/discussion/pmr-and-preexisting-knee-pain/

Also, I did find some related research that points out you are not alone with this question.
-- Patients' views on the causes of their polymyalgia rheumatica: a content analysis of data from the PMR Cohort Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278275/

That truly is an interesting question. My opinion is PMR causes "systemic inflammation." Most of the "PMR inflammation" is confined to specific areas of the body and only attacks certain tissues.

The "generalized inflammation" by its very nature can attack anywhere it wants to. It is carried in the blood stream and floats around looking for things to correct. I don't think inflammation just "selectively" looks for specific areas in the sense that PMR only attacks certain areas. Prior injuries would likely be areas where the immune system would think may need some additional work.

I had an old sports injury to my right knee that "bothered me" all my life. The knee pain I felt was definitely more during my PMR years. I had to get my knee replaced. My logic was maybe a knee replacement would help me reduce my prednisone dose. After my knee replacement surgery I was able to reduce my prednisone but still could not taper off Prednisone entirely.

Did your torn cartilage surgery happen back in the days when they automatically removed the cartilage?

I was told that I wouldn't need the cartilage!!!

I have "degenerative arthritis" in my spine too. I have no idea what caused that because I can't think of any back injury I ever had. I was diagnosed and have a "history of" inflammatory arthritis that caused significant lower back pain. Now my lumbar spine is a complete mess and needs a fusion. I don't want that surgery.

@dadcue it happened back in 1976 or so when I was playing softball. I thought I just sprained my foot/knee and got up and played the rest of the game. Next morning I got out of bed and fell flat on my face. Couldn't put any weight on the leg and it hurt really bad. I lived in South Dakota then and Aberdeen didn't have that big of a hospital. A piece of cartilage was floating loose and locked up my kneecap and I had surgery to remove it. Also had a local spinal tap for anesthesia and watched the procedure in the reflection of a glass cabinet in the small operating room. They had put up and curtain between my head and waist but didn't know I could see what was happening. A little surreal watching it because I felt nothing but could see surgeon and PAs holding my leg.

I also have degenerative arthritis in the spine which I think is just old age. Not sure I would want a fusion either but if I had real pain it might change my mind. Right now I just have lower back aches and poor posture, forward leaning when walking.

Same story except I hyper-extended my knee playing basketball in 1970. The immediate response from my basketball coach was to "ice it" so I did. I thought my knee was fine except the next day it swelled up as big as a basketball and wouldn't bend. After the swelling subsided, I took a hot bath every night and forced my knee to bend. I was 16 years old so what else was I supposed to do? I had another basketball game the following weekend so my leg needed to bend.

I played out the rest of the basketball season except my leg buckled a couple of times so I repeated the above process. By the end of basketball the season I had a noticeable limp so my coach asked if it was the same knee I hurt during the season. My coach wondered why I didn't see a doctor. I didn't know I was supposed to see a doctor!!

The orthopedic surgeon said my knee was "unstable." After surgery he said my knee was "deranged" and I wasn't supposed to play basketball anymore. I played anyway because it was my senior year. A loose piece of cartilage locked up my knee once but they scoped it out so that wasn't too bad.

I had another surgery which removed all the remaining cartilage from my knee. I'm not sure what else they did to my knee. The surgeon said I needed a knee replacement when I was 25 years old except I had to wait until I was at least 60 years old. I had knee replacements when I was 62 years old when they wouldn't do steroid injections anymore. They said the steroid injections were doing more harm than good.

I don't think PMR had anything to do with my knees but the surgeon said I was a poor surgical risk because of prednisone. That was when I first got acquainted with an endocrinologist who made sure I didn't have an adrenal crisis during my knee replacements.

I also have degenerative arthritis in lower back with no prior history of injury or familial predisposition.

This issue of interplay between osteoarthritis and PMR has been addressed by my rheumatologist at last visit. I have severe DJD in lumbar spine (virtually all discs are compromised), in neck and both shoulders (right one is “bone on bone”). Like you, no obvious reason other than aging. She says there isn’t much to be done and I will always have some degree of shoulder pain from the OA, and has encouraged me to try to tell the difference between the two types, which isn’t easy. Initially she wanted me on fairly high pred dose , and now wants me to taper (currently at 17.5 and reducing by 2.5 every two weeks). It is interesting to me that the OA became symptomatic only about six months before the PMR diagnosis, although I’m sure it would have been visible on imaging.

A quick (too quick) observation is that even if a body stress is not caused by PMR, and PMR is not caused by a particular body stress.
Stress is stress, and my experience is one can antagonize the other. And in fact if both are unaddressed, both effects can be magnified beyond the potential distress if they were independent.

I definitely had a low level inflammation in the knees and other joints (Osteoarthritis) before PMR hit but the PMR pain was in areas that were OK previously. I was listening to an explanation of autoimmune disease processes the other day and they used the bucket analogy. There are constant assaults or inputs on the immune system from diet, lifestyle, genetic changes, stress, injury, infection, environmental factors etc and when the bucket overflows, it can be very hard to get the level back into equilibrium. This is why we need to take a multi factorial approach to achieve a sustained remission. Im currently at 6mg Prednisone and the Osteoarthritis in the knees (which has been quiet for 9 months of Prednisone ) has really flared up worse than before PMR. I suspect i will pay a heavy price for the relatively pain free months !!

Cimmino, Marco Amedeo is the author of this paper :
. 2021 May-Jun;39(3):564-569. doi: 10.55563/clinexprheumatol/vn1qbp. Epub 2021 Mar 30.
Seasonal onset of polymyalgia rheumatica: correlations with the pattern of clinical presentation, disease severity and outcome in 383 patients from a single centre ( their conclusion-there is no correlation )

I actually emailed him to ask this question :
Is there a correlation of onset of PMR with a prior, RECENT injury ( for me it was a knee injury) ?
and he replied :
"As far as I know, there is no correlation between trauma and PMR, both considering the literature and the patients I followed."