Is it PMR?

Posted by rocksology @rocksology, Jan 10 12:34pm

As I've shared in the past, I have had terrible pain in my arms and legs (shoulders & hips) for over 10 years. I was relieved when I got my PMR diagnosis a year ago thinking there would be a way to control my pain. It also thought it gave me some credibility about my pain - it isn't all in my head, and it isn't fibromyalgia.
Mid November I went to the beach with my husband. I had had some problems with trigger finger on my middle finger on the right hand, but used my cane to walk anyway. On the second day both hands became swollen and I couldn't make a fist with the right. I thought for sure I had irritated my "mild" carpal tunnel. Eight weeks later, I finally was referred for an MRI on the hand. I was SHOCKED by the results.
My diagnosis changed in an instant to Seronegative Rhumatoid Arthritis. It is RA that doesn't show up on any bloodwork. We never would have figured it out if my hand hadn't blown up. Same treatments as PMR. So I guess now I'm in the wrong group.
Thank you all for your encouragement, knowledge and love in this group. I wish you all a pain free and happy New Year.
Terri

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

Terri. After being at this for some many years, you know they may yet change or they might just be adding Dx’s.
Of course with auto immune diseases we often end up with multiple diagnosis over time.
I started with PMR, immediately added GCI (Giant Cell) eventually they did add 1 or 2 more Arthritis forms.
Wish you wellness and the ability to find joy in the experience of the everyday.

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Profile picture for shoregirl @shoregirljill

Terri. After being at this for some many years, you know they may yet change or they might just be adding Dx’s.
Of course with auto immune diseases we often end up with multiple diagnosis over time.
I started with PMR, immediately added GCI (Giant Cell) eventually they did add 1 or 2 more Arthritis forms.
Wish you wellness and the ability to find joy in the experience of the everyday.

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@shoregirljill

"I started with PMR, immediately added GCI (Giant Cell) eventually they did add 1 or 2 more Arthritis forms."
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So true!!! I started out with reactive arthritis with uveitis about 15 years before PMR was diagnosed. When PMR was diagnosed I was naive to think that my diagnosis was being changed. I asked my rheumatologist what happened to reactive arthritis thinking maybe it was gone and PMR replaced it.

Subsequent to PMR being diagnosed there was degenerative osteoarthritis and gout. At one diagnostic review at my rheumatology visit I learned the I had the "full range" of rheumatology conditions and it would be impossible to adequately treat everything.

I stopped worrying about what diagnosis I had. Apparently my inflammation pathway is driven mostly by the IL-6 cytokine because Actemra works really well for me.

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Profile picture for leighton68 @leighton68

@ronludington no, I have pretty serious inflammatory bowl disease and the risk of bowl perforation made it not an option. I've spoke to a few who are taking it and the flu like symptoms are miserable.

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@leighton68 flu like symptoms when taking Kevzara? If yes, which symptoms?
I’m about to start Kevzara so I’m doing my best to be informed. I hate flu like symptoms.

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Profile picture for stonewheel @stonewheel

@leighton68 flu like symptoms when taking Kevzara? If yes, which symptoms?
I’m about to start Kevzara so I’m doing my best to be informed. I hate flu like symptoms.

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@stonewheel I haven't taken it but some have described it like having the flu. I tried methotrexate and that was worse then the flu.

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I’m sure I’ll end up on infusions eventually, but since I had a traveling Rheumatologist doctor change my diagnosis and take me off Methotrexate and prednisone and put it was chronic pain syndrome, (after a 7 minute appointment and no physical exam) it put me back to square one. I had to let my symptoms become severe enough to affect my hands and put me in bed to finally get imaging ordered to diagnose me.
I do feel a little better after two days on 5 mg prednisone and 10 mg leflunomide. I’ve been considering trying CBD lotion or a roll on.
Terri

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Profile picture for rocksology @rocksology

I’m sure I’ll end up on infusions eventually, but since I had a traveling Rheumatologist doctor change my diagnosis and take me off Methotrexate and prednisone and put it was chronic pain syndrome, (after a 7 minute appointment and no physical exam) it put me back to square one. I had to let my symptoms become severe enough to affect my hands and put me in bed to finally get imaging ordered to diagnose me.
I do feel a little better after two days on 5 mg prednisone and 10 mg leflunomide. I’ve been considering trying CBD lotion or a roll on.
Terri

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@rocksology I too had a floating rheumatologist, when his replacement came in, she undid everything he did changed my diagnosis and tried to put me on different meds with out looking into my medical history and all my other conditions! So frustrating! The medical community is a hot mess right now! And those of us with conditions suffer

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I decided a couple months ago to give up and stop going to any doctors. The gaslighting from specialists was destroying my mental health and doing nothing for my physical health or pain. It lasted less than 2 months. My hands became crippled starting with trigger finger and then they turned to claws. An MRI was already scheduled and Seronegative RA was the diagnosis. I haven’t seen anyone about that diagnosis, only spoke to the Rheumatologist on the phone to start meds.
I saw an Orthopedic surgeon which was the scheduled follow up on the MRI and she said I have a perfect storm going on with synovial fluid, some joint damage AND severe carpal tunnel from the swelling in my hand and carpal tunnel. She is going to go in to release the trigger finger and do the Carpal tunnel release. She is concerned my right middle finger will never be able to fully bend again.
She’s the first doctor in over a year who has been helpful. I couldn’t thank her enough.
Terri

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Profile picture for rocksology @rocksology

I decided a couple months ago to give up and stop going to any doctors. The gaslighting from specialists was destroying my mental health and doing nothing for my physical health or pain. It lasted less than 2 months. My hands became crippled starting with trigger finger and then they turned to claws. An MRI was already scheduled and Seronegative RA was the diagnosis. I haven’t seen anyone about that diagnosis, only spoke to the Rheumatologist on the phone to start meds.
I saw an Orthopedic surgeon which was the scheduled follow up on the MRI and she said I have a perfect storm going on with synovial fluid, some joint damage AND severe carpal tunnel from the swelling in my hand and carpal tunnel. She is going to go in to release the trigger finger and do the Carpal tunnel release. She is concerned my right middle finger will never be able to fully bend again.
She’s the first doctor in over a year who has been helpful. I couldn’t thank her enough.
Terri

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@rocksology

My analogy for having inflammatory arthritis and PMR was like a hurricane. If I took enough prednisone, I could mostly stay within the eye of the storm while the storm swirled all around me. I had to hunker down when prednisone introduced some additional swirls. Prednisone wasn't quite as bad as the hurricane but close.

My doctors were more like my lifeline. They prevented me from being swept away so I would recommend staying in touch with them. My doctors weren't in the hurricane but they managed to pull me out of it.

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Profile picture for Mike @dadcue

@rocksology

I'm on a biologic called Actemra (tocilizumab) which is in the same classification as Kevzara. They both work in the same way.

If you have inflammatory arthritis alone or in addition to PMR, it should be easier to get Actemra covered and paid for with original Medicare and a supplement. Actemra can be given as a monthly IV infusion. For some reason it is easier for inflammatory arthritis patients to be approved for a biologic when administered by an IV than it is for PMR patients to be approved for Kevzara as a weekly injection.

It is true that insurance companies want you to try less expensive options first. My rheumatologist didn't exaggerate when he said all other treatment options had failed in my case.

What seemed odd to me is that some people say prednisone is "the only and the best option for PMR." It is no wonder that research into better treatment options for PMR has lagged behind other autoimmune conditions. If patients believe prednisone is the only and best option for PMR then there isn't any need to find another option.

My rheumatologist thought Prednisone for the rest of my life wasn't a good outcome. My rheumatologist stated in the authorization request that "Actemra represented the best chance for me to ever get off Prednisone." It was clear he didn't believe prednisone for the rest of my life was a good option.

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@dadcue thank you for sharing your experience. I first got PMR in 2021. On prednisone for 20 months and then 3 years in remission . Started back on prednisone this March for PMR. I’ve noticed now though having pain in my hands and knees. Last visit to my NP said I may be developing RA or psoriatic arthritis. I’m concerned about going on a biologic, but it would be great to get off prednisone and I need to be open to other better treatments..

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Profile picture for rocksology @rocksology

Thank you for your words, I rarely feel as though I belong in groups. I appreciate you.
My Rheumy lives in Phoenix, I’m in Central Oregon. She is retired and is only here every 4 months. The other traveling doctor is here when she isn’t. He triggered my medical PTSD and I refuse to see him again as he messed with my head for weeks after my appointment with him.
The “good doc” is starting me on leflunomide and is putting me back on 5 mg prednisone. I have blood tests in seven days and every 30 days after that until she gets back. She told me the other jerk has to follow me while she’s gone, but I won’t go see him.
Meanwhile, I can’t take NSAID’s for pain, only a fever reducer - Tylenol. Nothing short of 20mg prednisone has helped the pain in the past. Maybe cortisone shots in my hands, shoulders and hips will help?
Terri

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"He triggered my medical PTSD and I refuse to see him again as he messed with my head for weeks after my appointment with him."
Mine too, a grouchy old narcissistic rheum who wrote, and hid, a very disparaging note about me. Make sure you request medical records and consult note!
Now I'm making them legally amend my records which included the note I wasnt allowed to see. They are legally required to respond in 60 days by attaching my amendment to the original unprofessional note. He could be accused of "Information blocking" ( I wasnt aware of the note for 9 months while its embedded in my Medicare records), Patient Abandonment" refused to diagnose or treat me without referral to someone else,
There are consequences if they do not act in 60 days.

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