Are painful swollen hands and fingers a PMR flare?

Or the possibility of subclinical RA prior to PMR.

My reactive arthritis wasn't exactly subclinical but I would go for long periods of time without any symptoms. The arthritic damage became apparent after PMR was diagnosed. I believe PMR exacerbated my preexisting condition. The arthritic damage did seem to appear practically overnight. The way prednisone masks the pain of inflammatory arthritis and osteoarthritis made it seem like it happened overnight.

One of the hardest concepts I had to grasp was how I could have both reactive arthritis and PMR. It was very clear to my rheumatologist but I had it all muddled together into a single problem responsive to prednisone.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328495/

I’m just saying that it could be RA. .. your symptoms seem consistent and i am curious why it was rejected as a diagnosis.

I mean the fact that it responded to Prednisone isn't definitive. Lots of pain sources respond to Prednisone.

On the other hand, TNF inhibitors (e.g. Humira, Remicade) don’t help PMR but do help RA.

And fyi virtually all of us concurrently have Osteo. But I don't think one predisposes us to the other. People have been getting osteo in their hands as long as we have roamed the earth 🙂

I don’t know—it really sounds like a lot of you might have arthritis and PMR. Classic PMR affects the shoulders, neck, upper arms, upper back and sometimes the muscles of the hips. Arthritis affects joints everywhere, but mine lately pops up in my hands and feet and I have some deformity from it. I had arthritis long before PMR and I can usually tell them apart. With arthritis flares in my joints it is so painful I can’t even walk if it’s in my ankles and feet. With PMR , my muscles are painful to touch and movement, but I can still move, if that makes any sense. It’s kind of hard to explain but it does affect me differently.

When i had my onset, it was in hands for two days, then it was shoulders, hips, ankles and was excruciating, accompanied by profound weakness. I couldn't sleep because if I rolled over my shoulders screamed. I had to put my shampoo bottle between my knees to squeeze because my hands were too weak.
My new Rheumy a few weeks later was inclined toward PMR but something made her give me a trial of Humira - and i had improvement in less than a week.

The point is that our maladies are more similar than different. I still occasionally get a period of the shoulders/hips thing and my Rheumy gives me 20 mg of Prednisone to taper down. But what I live with every day is RA. So do I have both or just some weird variant? Who knows - or cares. But you are correct that treating RA with Remicade won't do anything for the PMR symptoms. That takes Prednisone.

My Rheumatologist said osteoarthritis when I mentioned it to her but my primary care doctor said it can be a side effect of prednisone that is very common. My Rheumatologist doesn't seem to talk about side effects very often

Here is a helpful reference to osteoarthritis. https://www.arthritis.org/diseases/more-about/osteoarthritis-of-the-hands

It appears that what we are all experiencing is OA symptoms that were previously suppressed by our normal production of cortisol. If we were treated with prednisone for PMR, our adrenals stopped producing cortisol. As we taper off prednisone, our adrenals may be slow to resume cortisol production, and the decreasing prednisone dose is insufficient to control the OA discomfort. This can be expected to continue until we are off the prednisone, and we are producing sufficient cortisol again. If we never resume sufficient cortisol production, you may need to consult an endocrinologist. There are treatments other than prednisone that are preferred in that case. Best of luck on the difficult journey.

Yes, our usual doctors see people most often so are likely to see and know the side effects. Listed in the common side effects of Prednisone on the Mayo Clinic page are "swelling of the fingers, hands, feet, or lower legs" and "pain in the back, ribs, arms, or legs".

Pain in the wrists and hands was accepted by my doctor as part of the initial PMR diagnosis because it came on suddenly along with the elbows, shoulders and knees. After a year on prednisone I've also developed metatarsalgia in the balls of my feet making it painful to walk. Not sure what to blame for that. The problems while taking prednisone seem to go on and on.

I did not develop hand pain until I was completely off of Prednisone. It began with carpal tunnel that got progressively worse. Now I have synovitis, carpal tunnel and also tendonitis. I suddenly could not close my fingers into a fist. It literally happened overnight. So frustrating. The rheumatologist says it's RA, the orthopedic hand guy says it's carpal tunnel, and no one can help.

unfortunately you will have to guide your Dr's. I had carpel tunnel. I just kept pursuing until they sent me to a Dr that did the electro treatment. Not sure whats it called. That is a definitive test. They can also test for RA. I think the test is reasonably accurate if your off prednisone.

Thank you! We need to validate each other.