PMR to RA?

My PMR is in remission but I've always worried a little about RA since I do have degenerative arthritis and carpal tunnel in my hands. As a teenager I remember my mother struggling with RA which seemed to bother her hands the worse. I have often thought she might have had PMR that wasn't diagnosed prior to her RA. I thought you might want to scan through the other discussions and comments by members who have commented about PMR and RA. Here's a list of the discussions and comments - https://connect.mayoclinic.org/search/discussions/?search=PMR%20+RA

I did find an article on your question.
"FAQ's - Can PR turn into RA? - There is no current evidence that PR can turn into RA. The conditions have different underlying mechanisms."
-- Polymyalgia rheumatica vs. rheumatoid arthritis: https://www.medicalnewstoday.com/articles/polymyalgia-rheumatica-vs-rheumatoid-arthritis

You mentioned earlier that you are not taking anything for pain but were thinking about trying LDN. Do you mind sharing how long ago you were diagnosed with PMR?

Hi! I was diagnosed approx 3 years ago. I have just been weaned from prednisone for two months. Now my fingers have begun locking. I had hand and foot X-rays last week with labs. I’ll be following up with the rheumatologist in a week. They are afraid that I am converting/developing RA. I’m 54.

Sorry to hear the fingers are involved. Hoping you get some answers at your follow up with the rheumatologist. I have joint pain at the base of my thumbs but so far the fingers aren't too bad. I do try to do daily hand and finger exercises several times daily to try and maintain the flexibility. My first time with PMR was pretty awful and took me 3 and half years to taper off of prednisone with the last six months going back and forth between 1 mg and 1/2 mg of prednisone until I could stop taking it and my level of pain was less than 2 when I got up in the morning.

According to this source, it is "unlikely" for PMR to "convert" to RA.

"Can polymyalgia rheumatica turn into rheumatoid arthritis or vice versa?
It’s unlikely for one condition to cause the other. However, some people may receive diagnoses of both conditions in their lifetime. This is usually due to an initial misdiagnosis."
https://www.healthline.com/health/polymyalgia-rheumatica-vs-rheumatoid-arthritis#causes
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The following link states the following:

"Polymyalgia rheumatica (PMR) is a form of inflammatory arthritis that mainly affects the shoulders, arms, hips and low back. Symptoms like pain and stiffness often appear suddenly – sometimes literally overnight – but can also develop over a few days or weeks. They usually occur on both sides of the body, are worse in the morning or after resting and get better with movement. For some people, morning pain and stiffness can make it hard to get out of bed or dress. About one-third of patients also develop systemic symptoms like fever, fatigue and unintended weight loss. Unlike other types of arthritis, PMR doesn’t cause swollen joints, making it difficult to diagnose."
https://www.healthline.com/health/polymyalgia-rheumatica-vs-rheumatoid-arthritis#Whats-the-difference-between-rheumatoid-arthritis-and-polymyalgia-rheumatica?
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The bottom line is that PMR is hard to diagnose because other inflammatory conditions mimic PMR and vice versa.

I was diagnosed with a type of inflammatory arthritis called Reactive Arthritis (ReA) at the age of 32. Along with ReA, I had uveitis which is "associated" with Reactive Arthritis. Both of these disorders responded well to high dose prednisone followed by a fast taper. A fast response to Prednisone isn't "diagnostic" of PMR. However, PMR should respond quickly to Prednisone.

When I was 52 years old, I was diagnosed with PMR. At the time PMR was diagnosed, I thought my rheumatologist was changing my diagnosis from ReA to PMR. I asked her specifically, "What happened to ReA?" Her reply was, "Unfortunately I had both ReA and PMR."

What commonly happens --- having one autoimmune disorder puts you at risk of other autoimmune disorders.

"About 25 percent of patients with autoimmune diseases have a tendency to develop additional autoimmune disorders (3). The pathogenesis of multiple autoimmune disorders is not known. "
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150011/#:~:text=another%20autoimmune%20disease.-,About%2025%20percent%20of%20patients%20with%20autoimmune%20diseases%20have%20a,autoimmune%20disorders%20is%20not%20known.

I am wondering what you mean by 'fingers locking'. I had trouble with my thumb and a second finger locking/freezing. I finally blamed it on the statin I was taking. I have not had this problem since I quit taking statins.

I'm getting new symptoms since the PMR flare more than 6mths ago, which suggest to me that it may be progressing to RA. Or is it from the higher dose of prednisone I went back to (15mg) when I had the flare?

I have new growing bumps/nodules on the top of the second joints of my big toes and Morton's Neuroma in the balls of my feet. In the last month or so my right hip and groin have a new stabbing pain which I worry may be the start of hip problems which I haven't had before. Since the flare the two small fingers on each hand have been stiffer and the heels of my hands have sunken in and disappeared, changing the shape of my hands. It might be part of prednisone's fat redistribution as my face has widened slightly after the flare too. Strange that none of this happened in the first year of prednisone, not till after the flare and return of inflammation.

My Rheumatoid Factor blood test 2wks ago show my RF has risen from 23 IU/mL to 34 IU/mL in the last year. That's still in the "borderline" category (20 - 50 IU/mL), but it's being called "High" on my pathology results and is a decent rise, especially worrying considering the new symptoms. Yes, I believe it's possible for PMR to progress to RA, but I hope I'm wrong!

@dadcue ,@cgm
You know already that we are in that same boat, unfortunately.
I was diagnosed with reactive arthritis in my early twenties. Like you I was treated with a fast taper of prednisone. They also had me on Indocin and aspirin, cause in those days they did not have the biologics and medications they have now. I also had lots of physical therapy because I was a young mom and they were afraid my joints would stiffen up. I was lucky and all my joint issues cleared up and I was finally able to return to work a year later. And then I went into remission for 20 years! I also have osteoarthritis in my hands with a couple of nodes in my fingers.
PMR did not appear until I was 72( I just turned 75) and this is very different. I’m in my 2nd flare right now and my doctor wants me to take Actemra so hopefully I can get off the prednisone. I’m on 7.5 mg currently.

For about 20 years, all I knew was to start with 60 mg of Prednisone and do a fast taper for 30+ flares of uveitis. The flares of uveitis occurred once or twice per year. I didn't need a rheumatologist for the pain caused by reactive arthritis because I had more than enough Prednisone prescribed by my ophthalmologist. This all started at the age of 32. I didn't have any difficulty tapering off Prednisone -- 60 mg to zero in 4-5 weeks was "normal" for me.

PMR was diagnosed at the age of 52 but not until 6 months after the onset of my symptoms. It took several rheumatologists to eventually decide my new symptoms were being cause by PMR rather than reactive arthritis. I was told reactive arthritis didn't go away and it was "unfortunate" that I also had PMR.

After PMR was diagnosed, I was told to find a "stable dose" of Prednisone that worked and I would need to take Prednisone for an "extended period of time." My new normal Prednisone dose started at 40 mg and the extended period of time was 12+ years.

I wasn't able to taper off Prednisone until after Actemra was tried. I had many flares at 7 mg of Prednisone but those flares were probably caused by adrenal insufficiency.

"When cortisol levels are low, inflammation can increase because the body lacks immune regulation. Cortisol is a hormone that acts as an anti-inflammatory, and when levels are low, the body can't regulate inflammation properly. This can lead to a chronic pro-inflammatory response, which can cause a number of health issues."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/#:~:text=Cortisol%20is%20a%20potent%20anti%2Dinflammatory%20hormone%2C%20and%20its%20dysfunction,chronic%20pain%2C%20and%20salivary%20hypocortisolism.
Don't underestimate the effect that prednisone has on adrenal function and the HPA axis.

It is a pity how expensive Actemra is. I wish Actemra could have been tried sooner. There are currently two biosimilars to Actemra that are FDA approved. The cost should be decreasing soon.
https://www.centerforbiosimilars.com/view/fda-green-lights-second-tocilizumab-biosimilar
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If inflammatory arthritis like RA is a bigger problem then TNF inhibitors might also work. There are plenty of TNF inhibitors to choose from. My rheumatolgist says it is very difficult to adequately treat both PMR and inflammatory arthritis. Don't let anyone say you shouldn't try a TNF inhibitor because they won't work for PMR. It is true that TNF inhibitors aren't "recommended" for PMR. However, I think there are plenty of PMR sufferers who might also have inflammatory arthritis.
https://rheumatology.org/patients/tumor-necrosis-factor-tnf-inhibitors

I’ve had RA since 2007 and have only had 3 flareups since. My daughter passed away last November and by June I developed PMR that wasn’t diagnosed until August. Since then I’ve gone from 15 mg of Prednisone to 7.5 and may be stuck there for a while because many mornings are painful. Also in the past 2 weeks the knuckles in my right hand have begun to hurt and swell and this week my wrists also started to hurt. The first thing I suspected is that PMR is giving way to an RA flare up. My RA flareups have lasted 3-4 months and have occurred every 4-6 years but there seems to be no end in sight to this PMR and unfortunately the added grieving over my daughter has only added to the toll on my body. I concerned that if it becomes worse with the RA, I may have to go on Methotrexate or worse.

I’m so sorry for the loss of your daughter. Grief and pain are a difficult mixture. So glad we are all here to support each other. Sending a virtual hug your way.