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.
I’ve just been diagnosed with oesteo arthritis in knees hips hands and neck …it came up very suddenly everywhere rending me almost incapacitated…I stopped the methotrexate because I thought it was causing this new misery and have felt better in so far as not nauseous and less pain …this was after X-rays revealed the extent of the OA …I’m still on 1 mg of
prednisone,sulfasalazine ,hydroxychloroquine and bi weekly injections of Actemra ….im trying to stop the prednisone by switching to every other day but after a week I’m finding sleep difficult because of leg pains so am going back to daily in hopes it improves …its interesting to me to hear of others who suddenly got full body arthritic pains as it scared me wondering what other disease I had now …I’m adding Tylenol now for pain but the swelling in knees ankles and hands continues …I can’t tell now what’s PMR and what’s OA …sounds like others have had this scare so I’ll just have to adapt and hope for the best .
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."
I’ve just been diagnosed with oesteo arthritis in knees hips hands and neck …it came up very suddenly everywhere rending me almost incapacitated…I stopped the methotrexate because I thought it was causing this new misery and have felt better in so far as not nauseous and less pain …this was after X-rays revealed the extent of the OA …I’m still on 1 mg of
prednisone,sulfasalazine ,hydroxychloroquine and bi weekly injections of Actemra ….im trying to stop the prednisone by switching to every other day but after a week I’m finding sleep difficult because of leg pains so am going back to daily in hopes it improves …its interesting to me to hear of others who suddenly got full body arthritic pains as it scared me wondering what other disease I had now …I’m adding Tylenol now for pain but the swelling in knees ankles and hands continues …I can’t tell now what’s PMR and what’s OA …sounds like others have had this scare so I’ll just have to adapt and hope for the best .
I was able to get off Prednisone after Actemra was tried. I hope it also works for you.
I had advanced arthritis in my knees at the age of 25. The arthritis in my knees was caused by sports injuries and knee surgeries. I can't really remember when my knees didn't hurt so I was used to that pain.
At the age of 35, I was diagnosed with an autoimmune inflammatory arthritis called "reactive arthritis." I had a genetic predisposition for this type of arthritis that was triggered by an infection. Reactive arthritis is associated with another autoimmune condition called "uveitis." Reactive arthritis would mostly attack my spine. Uveitis was more serious and caused eye inflammation which can lead to vision loss. My ophthalmologist sometimes prescribed 100 mg of prednisone for uveitis.
PMR was a late addition to the inflammatory mess I was in at the age of 52. I wouldn't say I had full body arthritic pain suddenly after PMR was diagnosed. I can't remember when I didn't have arthritic pain because that started when I was 15 years old.
What happened suddenly were the flares of inflammatory arthritis. The pain was unbearable. The sudden onset of severe pain would happen in a matter of a day or two. As for uveitis, those flares happened suddenly and worsened within hours when my vision in one eye would become so foggy that I would be able to see my hand in front of my face. My ophthalmologist said my uveitis was "aggressive." Fortunately I never needed an appointment to be seen by my ophthalmologist. I would just call to report a flare of uveitis and they would create time for me.
I took massive doses of Prednisone before PMR was diagnosed. However, I never needed to take prednisone on a "long term" basis. I would usually take 60 - 100 mg of Prednisone to start but I could always do a fast taper and be off Prednisone again in a month or two for the flares of uveitis and reactive arthritis.
PMR didn't happen suddenly and progressed more slowly. A diagnosis wasn't easy to make because of my long standing history of inflammatory arthritis. PMR was a blessing to me because I was told to take prednisone every day for at least a year. The curse was when I wouldn't be able to taper off Prednisone again until 12 years later.
I think when PMR gets diagnosed, prednisone has a way of making you forget that you ever had arthritis. My rheumatologist stopped looking for arthritis and assumed it was everywhere. The pain caused by PMR and arthritis had a way of blending together and it became "generalized pain."
My rheumatologist at first said I had PMR in addition to reactive arthritis. Over time she said I had "systemic inflamation" or a "wide range of inflammatory conditions." After 12 years of PMR, my main medical problem was called "chronic prednisone use."
I was given a new lease on life after Actemra was started because I'm currently off prednisone. Prednisone relieved the pain but also did some serious harm to me. The sooner you can get off Prednisone the better off you will be. Prednisone relieved my pain but it didn't solve the problem. Prednisone also created additional "prednisone related" problems.
Sorry to hear of your problems with it all…I’ve been lucky and only developed all this in the last 4 yrs …and have had very little problems in my first 65 yrs …I too hope to be off the prednisone sooner rather than later …but the pain is certainly ever present and hard to fight .
Sorry to hear of your problems with it all…I’ve been lucky and only developed all this in the last 4 yrs …and have had very little problems in my first 65 yrs …I too hope to be off the prednisone sooner rather than later …but the pain is certainly ever present and hard to fight .
Yes ... you are right. The pain is hard to fight and it made me do things which I didn't want to do. Except for hydroxychloroquine, I took all the other medications you have listed at one time or another. My problem was I needed those medications in addition to higher doses of prednisone. Sulfasalazine was actually the very first medication I used for reactive arthritis and my rheumatologist wanted me to try it again after PMR was diagnosed.
My rheumatologist said if I could just stay on less than 5 mg of prednisone it would be okay. When Actemra got me off prednisone entirely, my rheumatologist was ecstatic. Now I just do a monthly infusion of Actemra and that is it ... no other medications to control pain. As an added bonus, I'm also off my blood pressure medications and several other medications used to treat prednisone side effects.
Are you sure you don't have inflammatory arthritis? There is no rule that says PMR and inflammatory arthritis can't coexist. It doesn't need to be PMR only or inflammatory arthritis only ... it can be both simultaneously. That might explain why you have full body arthritic pain and the swelling in your knees, ankles and hands continues. However, you are doing well to be on 1 mg of Prednisone except the inflammation might not be adequately controlled on that low of a dose.
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.
I am experiencing the same issues. I have osteoarthritis in my hips and knees with some changes in my lower back. It is difficult to distinguish between the two. Thanks for sharing
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.
I have severe DJD in my lumbar spine too. All the damage to my lumbar spine wasn't revealed until I was on a low dose of prednisone.
First I had pain in the area of my right buttocks. Someone said it was probably my piroformis muscle and related to PMR. That wasn't right because soon thereafter, the pain started to radiate down my right leg. I subsequently had right foot drop and dragged my right leg when I walked. The pain was so excruciating I had to go to the emergency room. An MRI was done which showed I had severe spinal stenosis and the nerves exiting my lumbar spine were compressed.
The pain was relieved when I took Prednisone but the spinal stenosis is still there and isn't getting any better. That sciatic nerve pain definitely wasn't PMR but Prednisone must have masked the pain for many years. I don't know how my lumbar spine got so bad. I told a doctor that I didn't know I had such a bad back. I even asked the doctor if he was sure it was my MRI.
I have severe DJD in my lumbar spine too. All the damage to my lumbar spine wasn't revealed until I was on a low dose of prednisone.
First I had pain in the area of my right buttocks. Someone said it was probably my piroformis muscle and related to PMR. That wasn't right because soon thereafter, the pain started to radiate down my right leg. I subsequently had right foot drop and dragged my right leg when I walked. The pain was so excruciating I had to go to the emergency room. An MRI was done which showed I had severe spinal stenosis and the nerves exiting my lumbar spine were compressed.
The pain was relieved when I took Prednisone but the spinal stenosis is still there and isn't getting any better. That sciatic nerve pain definitely wasn't PMR but Prednisone must have masked the pain for many years. I don't know how my lumbar spine got so bad. I told a doctor that I didn't know I had such a bad back. I even asked the doctor if he was sure it was my MRI.
@dadcue: My experience was very similar. I was previously active and doing a marathon gardening session last June, when I began experiencing lower back pain with bad sciatica. It did not improve and I ended up getting an MRI which revealed that every single disc in my lower back was herniated and pressing on nerves, as well as central canal stenosis. I had NO pain prior to this, which is not uncommon with osteoarthritis, I am told. A few months later, as part of my workup for PMR, I got shoulder and neck X-rays, again revealing severe OA. My rheumatogist says that prednisone can help with OA pain, but not dramatically. I am now on 17.5 mg, down from 40, and feelings lots of pain, both in shoulders/neck area and sciatica. I believe my tapering schedule will be determined more from labs than pain at this point. Labs have been at the high end of “normal” and going up as I have been tapering. I am not optimistic about getting off prednisone anytime soon.
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The 1st 2 yrs of my PMR (3.4yrs so far) my right knee ached…all other pain and stiffness was bilateral. I had a severe right twisted knee in HS.
I’ve just been diagnosed with oesteo arthritis in knees hips hands and neck …it came up very suddenly everywhere rending me almost incapacitated…I stopped the methotrexate because I thought it was causing this new misery and have felt better in so far as not nauseous and less pain …this was after X-rays revealed the extent of the OA …I’m still on 1 mg of
prednisone,sulfasalazine ,hydroxychloroquine and bi weekly injections of Actemra ….im trying to stop the prednisone by switching to every other day but after a week I’m finding sleep difficult because of leg pains so am going back to daily in hopes it improves …its interesting to me to hear of others who suddenly got full body arthritic pains as it scared me wondering what other disease I had now …I’m adding Tylenol now for pain but the swelling in knees ankles and hands continues …I can’t tell now what’s PMR and what’s OA …sounds like others have had this scare so I’ll just have to adapt and hope for the best .
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2 ReactionsThank you for your replies!
I was able to get off Prednisone after Actemra was tried. I hope it also works for you.
I had advanced arthritis in my knees at the age of 25. The arthritis in my knees was caused by sports injuries and knee surgeries. I can't really remember when my knees didn't hurt so I was used to that pain.
At the age of 35, I was diagnosed with an autoimmune inflammatory arthritis called "reactive arthritis." I had a genetic predisposition for this type of arthritis that was triggered by an infection. Reactive arthritis is associated with another autoimmune condition called "uveitis." Reactive arthritis would mostly attack my spine. Uveitis was more serious and caused eye inflammation which can lead to vision loss. My ophthalmologist sometimes prescribed 100 mg of prednisone for uveitis.
PMR was a late addition to the inflammatory mess I was in at the age of 52. I wouldn't say I had full body arthritic pain suddenly after PMR was diagnosed. I can't remember when I didn't have arthritic pain because that started when I was 15 years old.
What happened suddenly were the flares of inflammatory arthritis. The pain was unbearable. The sudden onset of severe pain would happen in a matter of a day or two. As for uveitis, those flares happened suddenly and worsened within hours when my vision in one eye would become so foggy that I would be able to see my hand in front of my face. My ophthalmologist said my uveitis was "aggressive." Fortunately I never needed an appointment to be seen by my ophthalmologist. I would just call to report a flare of uveitis and they would create time for me.
I took massive doses of Prednisone before PMR was diagnosed. However, I never needed to take prednisone on a "long term" basis. I would usually take 60 - 100 mg of Prednisone to start but I could always do a fast taper and be off Prednisone again in a month or two for the flares of uveitis and reactive arthritis.
PMR didn't happen suddenly and progressed more slowly. A diagnosis wasn't easy to make because of my long standing history of inflammatory arthritis. PMR was a blessing to me because I was told to take prednisone every day for at least a year. The curse was when I wouldn't be able to taper off Prednisone again until 12 years later.
I think when PMR gets diagnosed, prednisone has a way of making you forget that you ever had arthritis. My rheumatologist stopped looking for arthritis and assumed it was everywhere. The pain caused by PMR and arthritis had a way of blending together and it became "generalized pain."
My rheumatologist at first said I had PMR in addition to reactive arthritis. Over time she said I had "systemic inflamation" or a "wide range of inflammatory conditions." After 12 years of PMR, my main medical problem was called "chronic prednisone use."
I was given a new lease on life after Actemra was started because I'm currently off prednisone. Prednisone relieved the pain but also did some serious harm to me. The sooner you can get off Prednisone the better off you will be. Prednisone relieved my pain but it didn't solve the problem. Prednisone also created additional "prednisone related" problems.
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1 ReactionSorry to hear of your problems with it all…I’ve been lucky and only developed all this in the last 4 yrs …and have had very little problems in my first 65 yrs …I too hope to be off the prednisone sooner rather than later …but the pain is certainly ever present and hard to fight .
-
Like -
Helpful -
Hug
2 ReactionsYes ... you are right. The pain is hard to fight and it made me do things which I didn't want to do. Except for hydroxychloroquine, I took all the other medications you have listed at one time or another. My problem was I needed those medications in addition to higher doses of prednisone. Sulfasalazine was actually the very first medication I used for reactive arthritis and my rheumatologist wanted me to try it again after PMR was diagnosed.
My rheumatologist said if I could just stay on less than 5 mg of prednisone it would be okay. When Actemra got me off prednisone entirely, my rheumatologist was ecstatic. Now I just do a monthly infusion of Actemra and that is it ... no other medications to control pain. As an added bonus, I'm also off my blood pressure medications and several other medications used to treat prednisone side effects.
Are you sure you don't have inflammatory arthritis? There is no rule that says PMR and inflammatory arthritis can't coexist. It doesn't need to be PMR only or inflammatory arthritis only ... it can be both simultaneously. That might explain why you have full body arthritic pain and the swelling in your knees, ankles and hands continues. However, you are doing well to be on 1 mg of Prednisone except the inflammation might not be adequately controlled on that low of a dose.
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2 ReactionsI agree something is not at the right dose …atm I don’t know what should be increased …
I am experiencing the same issues. I have osteoarthritis in my hips and knees with some changes in my lower back. It is difficult to distinguish between the two. Thanks for sharing
I have severe DJD in my lumbar spine too. All the damage to my lumbar spine wasn't revealed until I was on a low dose of prednisone.
First I had pain in the area of my right buttocks. Someone said it was probably my piroformis muscle and related to PMR. That wasn't right because soon thereafter, the pain started to radiate down my right leg. I subsequently had right foot drop and dragged my right leg when I walked. The pain was so excruciating I had to go to the emergency room. An MRI was done which showed I had severe spinal stenosis and the nerves exiting my lumbar spine were compressed.
The pain was relieved when I took Prednisone but the spinal stenosis is still there and isn't getting any better. That sciatic nerve pain definitely wasn't PMR but Prednisone must have masked the pain for many years. I don't know how my lumbar spine got so bad. I told a doctor that I didn't know I had such a bad back. I even asked the doctor if he was sure it was my MRI.
@dadcue: My experience was very similar. I was previously active and doing a marathon gardening session last June, when I began experiencing lower back pain with bad sciatica. It did not improve and I ended up getting an MRI which revealed that every single disc in my lower back was herniated and pressing on nerves, as well as central canal stenosis. I had NO pain prior to this, which is not uncommon with osteoarthritis, I am told. A few months later, as part of my workup for PMR, I got shoulder and neck X-rays, again revealing severe OA. My rheumatogist says that prednisone can help with OA pain, but not dramatically. I am now on 17.5 mg, down from 40, and feelings lots of pain, both in shoulders/neck area and sciatica. I believe my tapering schedule will be determined more from labs than pain at this point. Labs have been at the high end of “normal” and going up as I have been tapering. I am not optimistic about getting off prednisone anytime soon.