Are painful swollen hands and fingers a PMR flare?

I don't think PMR "causes" osteoarthritis (OA) or inflammatory arthritis.

PMR might make arthritis worse if you already have arthritis. Given that people are older when they are diagnosed with PMR, I think most people with PMR have some arthritis.

I don't think prednisone prevents the progression of any type of arthritis.

Prednisone reduces the inflammation and eases the pain but I don't think prednisone prevents anything.

A sustained remission of PMR is difficult to achieve with prednisone. Some people say a "new batch of inflammatory substances are released every day" --- that doesn't sound like remission to me.

These are my opinions for what they are worth.
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Inflammatory arthritis is different compared to osteoarthritis (OA). The "damage" that is caused by both inflammatory arthritis and osteoarthritis will eventually look similar but maybe more severe in the case of inflammatory arthritis. However, osteoarthritis can be severe too.

PMR doesn't help inflammatory arthritis or osteoarthritis. Having any type of arthritis with PMR shouldn't be allowed in my opinion!

I am tapering my prednisone dose and am now down to 5mg . My rheumatologist wants me to stay there until I see him in October. I'm taking it because I have Giant[Large] Cell Arteritis, a complication of PMR. I also have a weekly injection of Actemra. But, like you I developed Type 2 diabetes . I was not impressed. I could not tolerate Metformin[ I was hospitalised] so I have been having insulin. Now I have just been told that I can stop the insulin which delights me. Like you I have been fairly strict with my diet , I have lost 6 kgs but always wonder what is next going to happen due to prednisone. I see my ophthalmologist next week because all this drug taking has been to save my eyesight.

Not any minor illness - specifically, any infection can trigger reactive Arthritis.

I had similar hand problems after a year of PMR, without having taken prednisone.

Do you continue to have pain in yr hands?

I'm not a doctor but from what I've been told by my Rheumatologist and what I have read, you probably should have been started on 20 mgs of Prednisone right off the bat. It may be a little of both, but not sure if osteoarthritis causes weakness in hands. That sounds more like a PMR symptom.

Mary, Doc put me on Meloxicam on Tuesday for the pain and stiffness in the hand and wrist. Non-steroidal anti inflammatory. Described it as a little mallet as opposed to the big hammer of prednisone. By Thursday no more pain or stiffness. But, is an NSID and have to watch for internal bleeding and no alcohol 🍺.

And an RA thing…

No, the pain moves around, as it has from the beginning. The original hip pain is almost gone, the shoulder pain is much less, knee pain gone completely, hand pain sometimes returns. Right now it’s in my back and ribs, which is awful, but is getting better. I don’t know what to expect next, but I never wish I had taken prednisone.

Looking at the side effects of Prednisone per Mayo Clinic, I'm now wondering if it's your osteoarthritis and/or a recurrence of the PMR. I also had pain/stiffness in my hands and now that my Prednisone is reduced to 2 and 3 mgs every other day, my symptoms are coming back. Here's a list of side effects from Mayo Clinics website, but keep in mind there are always exceptions to the rule:

Side effects of corticosteroids taken by mouth:
Corticosteroids that you take by mouth affect your entire body. For this reason, they are the most likely type of corticosteroid to cause side effects. Side effects depend on the dose of medication you receive and may include:

A buildup of fluid, causing swelling in your lower legs.
High blood pressure.
Problems with mood swings, memory, behavior, and other psychological effects, such as
confusion or delirium.
Upset stomach.
Weight gain in the belly, face and back of the neck.

When taking corticosteroids by mouth for a longer term, you may experience:
Problems with the eyes, such as glaucoma or cataracts.
A round face, which is sometimes called moon face.
High blood sugar, which can trigger or worsen diabetes.
Increased risk of infections, especially with common bacterial, viral and fungal
microorganisms.
Bone fractures and thinning bones, called osteoporosis.
Fatigue, loss of appetite, nausea and muscle weakness.
Thin skin, bruising and slower wound healing

I hope this helps you and somehow you can get answers to your issues very soon.