Is it PMR (and/) or Osteoarthritis?

I am about the same stage of PMR as you 8 months in, on 5mg mornings and 2.5mg afternoons, pain levels about the same as you. Still know the disease is rumbling along because of the shoulder, neck arms and hands stiffness in morning, didnt have that before PMR. Also have osteo in both hips and knees and that pain feels more like osteo pain than PMR pain. My hip pain is located on the outer aspect and i can feel that it is in the joint space. If it was in the groin area, i might be concerned that it was referred pain from the spine.

@dadcue You and I share a similar story. Developed PMR 11 years ago and was never able to go off prednisone until starting Kevzara about 1 1/2 years ago. But after starting Kevzara I developed osteoarthritis. Is it a side effect of the Kevzara or independent osteoarthritis? X-rays show moderate arthritis but the pain is more than moderate. Meloxicam helps but I’m a bit afraid of it

@rayabw
Prednisone is indiscriminate and reduces all inflammation, including osteoarthritis that will return at low dose or elimination of prednisone. I'm feeling it during my prednisone tapering because the pain that I had gotten used to gradually over time has returned all at once. Prednisone doesn't cure anything. It only takes away the inflammatory pain.

@rayabw

Osteoarthritis isn't a side effect of Kevzara. Most people our age have at least some "degenerative arthritis" which is caused by the "wear and tear on our joints" that happens over the years as we get older.

There is another kind of arthritis which collectively is called "inflammatory arthritis." People with rheumatoid arthritis (RA) have one kind of inflammatory arthritis which people know about. People who have RA tend to have severe damage to their joints.

PMR is an inflammatory condition that involves inflammation in the soft tissues surrounding the bone joints. It doesn't usually involve the actual bone joints themselves. It is said that PMR doesn't cause any bone joint damage but I believe it exacerbates osteoarthritis, makes it worse and causes it to hurt more.

As artificial intelligence says:

"Polymyalgia rheumatica (PMR) does not cause joint damage, but widespread systemic inflammation can amplify overall pain perception and make pre-existing osteoarthritis feel significantly more severe and painful."

I agree as the medication I am taking ie prednisone and methotrexate has provided relief from pain in muscles and returned full movement with the help of physiotherapy. Other osteoarthritis problems are still there but very mild. For example my thumbs which had been very painful, stiff are now working again. Only a slightly tender at the joint which doesn’t cause a problem now when using .

I found a good physical therapist who I hope is developing me a good exercise program without overdoing it.
The physical therapy is directly connected to the orthopedic group and hopefully there is good communication between the therapist and Drs. if necessary.

After first having pain in the arms, neck and shoulders, I developed pain in my lower back. The prednisone caused osteoporosis, thus 2 fractures in my back.
Severe pain for weeks, so bad I had to use a wheel chair for a couple of weeks. The rheumatologist ordered a Prolea shot. In 3 weeks I had no pain. The shot had built back enough bone to heal the fractures.

After taking Prednisone for 18 months, I tapered off in November 2025, with the help of Actemra infusions. I'm still getting the monthly infusions. About 3 weeks after my taper ended, I started having joint pain--knees, fingers, thumbs, wrists, and shoulders. I was waking up at night with severe stabbing pains in my wrists. Also, I'd wake up with shoulder aches, that radiated down my arm to my knuckles. My rheumy prescribed celebrex. He suspected osteoarthritis. In May, he switched me to nabumetone, an NSAID, because I wasn't getting much relief with the celebrex. I still wake up nightly with shoulder/arm pains. Last week, I went to an orthopedic surgeon, who ultrasounded all my joints from my fingertips to my shoulders. His report stated that I have degenerative arthritis in my hands, and my wrists, elbows and shoulders raises the possibility of inflammatory arthritis. I never had these types of pains prior to GCA/PMR. Yes, I'm 70 years old, but prior to GCA/PMR I was very active, physically. I was always in high gear.

I sent the ortho's report to my rheumy. I have a telephone appointment with him tomorrow (he's in another state). Now, that we know what is causing the pains, I'm hoping to find out some answers regarding my treatment. Some of my questions are: are we utilizing the best treatment options for me and will cortisone shots help with inflammatory arthritis?

I've asked my rheumatologist whether the PMR diagnosed two years ago and for which I take 5-6 mgs of Prednisone could also be recurring arthritis and/or back pain resulting from congenital minimum scoliosis, or a back injury suffered 20-plus years ago - all of which are likely to recur more often as I age (now 83).

So how much of it is PMR, or arthritis, or scoliosis, or the injury, and how much is Prednisone actually treating PMR? Is it even possible or important to know this well enough to perhaps lower the Prednisone so that it's aimed just at PMR? His response mostly was to agree that it is difficult to determine and we left it at that. Has anyone here discussed this with their doctor?

@tug25
Hi,
Your question is a good one and probably the right answer would be complex. But I was on Prednisone for a year after getting PMR diagnosed. While taking it I did notice hip pain beyond the baseline for me on prednisone. So, once I stopped prednisone, it became very apparent that I had a bad hip. Standing and walking were nearly impossible. Last Tuesday, I had my hip replaced. And boy, am I ever glad. I see in my mind that shiny ball rotating with ease, as if greased. Thanks for this forum!