Are painful swollen hands and fingers a PMR flare?

"Your immune system begins to react to something - a virus or allergen or bacteria or such and something triggers that immune process to dial it up - and it doesn't get a signal to stop. So now your immune process is in overdrive and the mechanism to slow it down is stuck."

I like this explanation! It sounds like reactive arthritis to me.

Endogenous cortisol from the adrenals is supposed to regulate inflammation ... not prednisone. Maybe the adrenals get overwhelmed by the excess amount of inflammation when the immune process goes into overdrive. Maybe the adrenals can't produce enough cortisol relative to the amount of inflammation. Prednisone works because it floods our body with exogenous synthetic cortisol.

Too much endogenous cortisol and exogenous synthetic cortisol causes an oversupply of corticosteroid. This causes a problem because too much corticosteroid is just as bad as not enough. If we persist with taking prednisone the adrenals take a holiday. The adrenals shut down the production of cortisol in an attempt to restore the proper amount corticosteroid.

The whole system that regulates inflammation (HPA axis) gets screwed up the longer we take prednisone. It isn't just inflammation that is regulated by the HPA axis --there are other things that become unregulated. My blood pressure and cholesterol levels went through the roof for example.

When the adrenals don't function, a major malfunction ensues.

"Your immune system begins to react to something - a virus or allergen or bacteria or such and something triggers that immune process to dial it up - and it doesn't get a signal to stop. So now your immune process is in overdrive and the mechanism to slow it down is stuck."

I like this explanation! It sounds like reactive arthritis to me.

Endogenous cortisol from the adrenals is supposed to regulate inflammation ... not prednisone. Maybe the adrenals get overwhelmed by the excess amount of inflammation when the immune process goes into overdrive. Maybe the adrenals can't produce enough cortisol relative to the amount of inflammation. Prednisone works because it floods our body with exogenous synthetic cortisol.

Too much endogenous cortisol and exogenous synthetic cortisol causes an oversupply of corticosteroid. This causes a problem because too much corticosteroid is just as bad as not enough. If we persist with taking prednisone the adrenals take a holiday. The adrenals shut down the production of cortisol in an attempt to restore the proper amount corticosteroid.

The whole system that regulates inflammation (HPA axis) gets screwed up the longer we take prednisone. It isn't just inflammation that is regulated by the HPA axis --there are other things that become unregulated. My blood pressure and cholesterol levels went through the roof for example.

When the adrenals don't function, a major malfunction ensues.

Thats very insightful. I tend to think of
Reactive Arthritis>>RA>> PMR as a continuity of overlapping conditions with distinctions that are more than just severity or duration. But we don’t understand the ‘why’ that’s in play. Why do we get one condition versus another and what are the differences in triggers.
It interests me because my son got Reactive Arthritis following knee surgery. My Rheumy in NYC was torn whether I had PMR or sero negative RA. She had a hunch and gave me Humira in her office -and five days later i began to improve. But if she had loaded me up on prednisone I would also have improved.
So the ABC’s of this triad of conditions really is fascinating to me.

"So the ABC’s of this triad of conditions really is fascinating to me."

It isn't just these three conditions.... it is all autoimmune conditions. I think they all have more in common than what makes them different. Years ago, conditions like this fell under the broad heading of rheumatism. Now there are more than 200 distinct rheumatic diseases. I don't think they are that distinct. This is especially true when you can have more than one condition going on. My rheumatologist said I had a full range of things going on.

The common denominator is inflammation. I think it boils down to what is the best way to treat autoimmune inflammation. I'm not sure prednisone is the best way. All the inflammation pathways are fascinating to me. My rheumatologist says there aren't single individual inflammation pathways. It is more like a network of pathways with cross talk, upstream and downstream regulation and all sorts of things happening.

I'm just happy that Actemra works well for me. My last infusion was 7 weeks ago because of extensive travel. My rheumatologist knew it was going to be a long time between infusions so he sent some prednisone with me in case I needed it. I didn't need the prednisone but now I'm wondering if I still need Actemra.

"Your immune system begins to react to something - a virus or allergen or bacteria or such and something triggers that immune process to dial it up - and it doesn't get a signal to stop. So now your immune process is in overdrive and the mechanism to slow it down is stuck."

I like this explanation! It sounds like reactive arthritis to me.

Endogenous cortisol from the adrenals is supposed to regulate inflammation ... not prednisone. Maybe the adrenals get overwhelmed by the excess amount of inflammation when the immune process goes into overdrive. Maybe the adrenals can't produce enough cortisol relative to the amount of inflammation. Prednisone works because it floods our body with exogenous synthetic cortisol.

Too much endogenous cortisol and exogenous synthetic cortisol causes an oversupply of corticosteroid. This causes a problem because too much corticosteroid is just as bad as not enough. If we persist with taking prednisone the adrenals take a holiday. The adrenals shut down the production of cortisol in an attempt to restore the proper amount corticosteroid.

The whole system that regulates inflammation (HPA axis) gets screwed up the longer we take prednisone. It isn't just inflammation that is regulated by the HPA axis --there are other things that become unregulated. My blood pressure and cholesterol levels went through the roof for example.

When the adrenals don't function, a major malfunction ensues.

I will tell you what my Rheumy told me in December when i had had a long stretch of no flares, and only a low hum baseline of pain. I questioned whether we should dial back frequency of infusions or dial down dosage per kg. He said lets bring this up in March. When we’ve spent two years of tweaking to get here, I don’t really want to change anything.

Because of traveling, I had my Actemra infusion yesterday after 7 weeks instead of 4 weeks. My CRP and ESR were checked prior to my Actemra infusion. While my pain wasn't that significant, my inflammatory markers were elevated. My inflammatory markers went from "negligible" to "significantly elevated" according to my rheumatologist --- the first increase in a couple of years.

I was never sure why we were still checking my inflammatory markers, Supposedly they aren't reliable when a person is on Actemra. My rheumatologist said my inflammation markers are still an indicator when something isn't right or when Actemra isn't working for some reason.

When I asked if I still needed Actemra ... my rheumatologist said based on my inflammation markers .... I still need Actemra. My rheumatologist asked me why I would want to stop Actemra. I didn't have any reason to stop Actemra other than to see what might happen. My rheumatologist said he could probably predict what would happen if we stopped Actemra.