Are painful swollen hands and fingers a PMR flare?

Posted by deborahinmaine @deborahinmaine, May 15 11:56am

I got off prednisone for PMR after almost 3 years in April. In February I had woken with swollen painful hands and fingers. Because of how I sleep it was diagnosed unseen as carpal tunnel. Finally saw my rheumatologist and she thinks it could be a PMR flare,didn’t look like carpal tunnel. That makes sense to me but she has put me back on only 3mg. of prednisone. I have no strength in my hands and can’t make a fist. Very limited in what I’m able to do.
When first diagnosed with PMR and in terrible pain this same rheumatologist started me on 5mg. of prednisone which did nothing.
Finall got up to 20mg. And got some relief.
Has anyone else had issues with your hands during or after being on prednisone for PMR? I also just found out there is osteoarthritis in my hands.
Thanks!

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

So my sed rate 60 and crp 87 were elevated. RF, ANA, anti-ccp negative. I seemed to 'fit the bill' for pmr. Along the way and looking back, I.have had symptoms fitting the bill for reactive arthritis. Getting my crp, sed rate and HLA-B27 tests Sat or Mon. Started PT for Achilles tendonitis yesterday.
Anybody used kinesio tape? The science behind it is interesting. It started to really bother me and I pulled it off at 2 am. Thinning skin is making me dubious using it.
I would think by now at 75 I should have more physical symptoms if rheumatoid arthritis is my main problem. Could be wrong. If you can find out what your system is lacking and get to the root of the problem guesswork is minimized but that involves sophisticated testing.
I think my HLA-B27 will be positive, now hoping my insurance will cover it,

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@formerpaa70

Same hand symptoms but doc ruled out RA. He says osteoarthritis. And PMR can affect hands. Who knew?

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I don't think my hands have RA only because there isn't any swelling or joint enlargement as I've seen with people with RA. Due to see my rheumatologist soon and am curious as to what she thinks.

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@pb50

I just want to clarify that i’m not challenging you for the sake of it. I am hoping for you there’s a path to a diagnosis of RA rather than PMR. One - you avoid a lifetime of challenges associated with Prednisone. Two - there is a larger number of effective treatment paths with RA. And transitioning from one to another is fairly straightforward compared to stopping Prednisone.

I have some osteo. Almost all of us do. I don't have noticeable swelling in my hands. Other than symptoms that could be related to age and drugs, like fatigue and pain and weakness, if I wasn't positive for RA Factor you might be justified in questioning my diagnosis. But the week before my infusion of Remicade and the week after tells the story.

I wish you all the luck as you go forward!

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I diagnosed myself with PMR in Apr 2021. No other issues. Healthy 68. I have genetic cholesterol. I pulled my blood tests after being steroids for 4 weeks. So not a true test. My wife has GBM and I see first hand the ravages of steroids. The brain is not an easy place for excess inflammation. I was off steroids in 6 months. I went 2 yrs clean no issues. This last year I am on my 3rd flare. I stay on this site to learn more about others long term. I had hoped once and done. I also hoped to advocate that it is not the PMR that is necessarily causing the PMR symptoms. Its the steroid. I also would like to learn about others dealing with flares. I mean a true flare. Not a flare when reducing steroids. I know what causes that flare. I have dealt with my PMR flares with a 5 day pack of steroid. Similar to what they would prescribe for asthma. I am not interested in taking any additional medications if I can help it. For every action there is a reaction. Even that 5 day pack increase my BP and I always gain 4-5 pds. Many on this site understand what the steroids do to your body and how it affects PMR. Many just take the drug. I hope to help. If they every designed a disease to fit the drug it was PMR and steroids. The steroids are almost like taking Heroin. Not that I every have.

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@rosemargaret

I don't think my hands have RA only because there isn't any swelling or joint enlargement as I've seen with people with RA. Due to see my rheumatologist soon and am curious as to what she thinks.

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Many many people were not diagnosed early enough in the course of their disease. I see them in the infusion room all the time. And their hands are frightening. But that’s not an unavoidable outcome. I rarely have swelling or enlarged joints in my hands and I've had RA for 12+ years. There is not a single presentation but I was put on Humira within days of my onset and i stay on top of it. I take Prednisone for every material flare and start tapering off on day 1. So joint deformation has never had a chance. There is not a single course of symptoms. And there is a wide range of treatments. But you have to be an active participant in the outcome.

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@pmrsuzie

So my sed rate 60 and crp 87 were elevated. RF, ANA, anti-ccp negative. I seemed to 'fit the bill' for pmr. Along the way and looking back, I.have had symptoms fitting the bill for reactive arthritis. Getting my crp, sed rate and HLA-B27 tests Sat or Mon. Started PT for Achilles tendonitis yesterday.
Anybody used kinesio tape? The science behind it is interesting. It started to really bother me and I pulled it off at 2 am. Thinning skin is making me dubious using it.
I would think by now at 75 I should have more physical symptoms if rheumatoid arthritis is my main problem. Could be wrong. If you can find out what your system is lacking and get to the root of the problem guesswork is minimized but that involves sophisticated testing.
I think my HLA-B27 will be positive, now hoping my insurance will cover it,

Jump to this post

I don't think its a matter of something you're lacking. It seems to be more like a stuck switch. Your immune system begins to react to something - a virus or allergen or bacteria or such and something triggers that immune process to dial it up - and it doesn't get a signal to stop. So now your immune process is in overdrive and the mechanism to slow it down is stuck.
They don't understand fully what triggered that malfunction - but they have figured out how to stop and in many cases to prevent it - mostly.

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@kmw24

I began having tingling in right hand in March. I still have that and since March that has progressed to sharp shooting pain in my fingers, it goes up into my forearm up into my elbow. I am unable to make a fist because of stiffness and pain which gets better in the afternoon, but then returns in the evening. nighttime has been horrible with pain in my hand and arm. I have not only had sharp pain on different areas of my hand. I have had burning pain in my hand that feels like it’s on fire at night when I’m trying to sleep. I was diagnosed with PMR a number of years ago. I was on prednisone and I went into remission, but I feel like I am back with full-blown PMR and will be seeing the rheumatologist I saw then this coming week. I have a little bit of this in my left hand, but not at all like my right hand. I have OA which runs in the maternal side of my family and I’ve had since it since my early twenties. I’ve had neuropathy in my feet which has gone away for the most part.
I’m wondering how anyone’s rheumatologist distinguished PMR in hands as opposed to carpal tunnel. Before the hand issues, I was having what I thought was a PM flare with aching arms and hips.. I have an appointment with a hand doc for what looks like Dupuytren’s Contracture which runs in my family on paternal side. As it happens that appt is day before appointment with Rheumatologist. Has anyone had this type of symptom/diagnosis issue? Thank you.

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I was diagnosed with PMR in 2018 and was put on a regiment of prednisone and then methotrexate. The prednisone helped greatly with the pain but the side effects were terrible. I then went on methotrexate which was supposed to suppress the immune system. I didn't like that idea so started to do research myself and try to find a way to treat this without using prescription drugs. My research led me towards cannabis and hemp products. I have been using cbd oil for the last 5 years and have had great success treating the symptoms associated with pmr. As far as I know I have had zero side effects from its use and have had more benefits such as relief from the pain of arthritic knees. CBD oil is not cheap so I looked for a way to reduce my costs. I started making my own using cbd isolate and mixing it with mct oil. This has worked for me for the last 5 years, until about 2 weeks ago. It seems I have had a pmr relapse. From what I understand there isn't a defined trigger that causes pmr flair ups or even what causes the disease. In my case I think flair up might have been caused by over doing it when I was doing all the spring clean up on my property. I went hard at it to get it done quickly instead of doing a little at a time. I am now paying the price. The symptoms are as bad if not worse than they have ever been. The thing that caught my attention about your symptoms is the burning hands at night time. I have the same thing. It seems whenever I lay flat my arms start to tingle and it works its way down to my hands and my hands tingle and then start to fall asleep. Shortly after that I get a very strong burning sensation in my hands and throbbing pain in some of my fingers. I find if I sit up for a few minutes the pain and tingling goes away but comes back shortly after laying down again. It makes for sleepless nights. Most of my pain is in my shoulders and I'm wondering if this inflammation is causing decreased blood flow to my arms thus causing the problems in my hands. Maybe sitting up uses the effect of gravity to help with blood flow. My symptoms are slowly getting better and I am taking a stronger mix of cbd oil in the meantime. Hopefully this is just a short term set back with this disease and I can get back to the pain free existence I was having living previously living with pmr.

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That's amazing that you've had such results from cbd. Well done. It's certainly a finicky disease. My hands hurt MJHS hell in the morning. I have cbd oil, I will try today

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I watched a short video "Statin-Induced Myopathy" which started me thinking. Sometimes I think too much. I know this could/should be in the discussion about statins causing pmr but something Dadcue said up above prompted my thoughts. The particular problem mentioned was not being able to grip anything. muscle weakness? Myopathy? The rheumatologist talks about combination of medicines patients take, risk factors like being overweight, hypothyroidism, exercise. I just found it interesting. Not sure I can post a link to a video though.

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@rosemargaret

I don't think my hands have RA only because there isn't any swelling or joint enlargement as I've seen with people with RA. Due to see my rheumatologist soon and am curious as to what she thinks.

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When I tapered to about 7, I started having mild wrist/finger/thumb pains in the AM. The pain was usually gone by 1400, most probably due to morning prednisone taking effect. Wrist imaging showed a mild case of osteoarthritis, which is probably the cause. I am continuing to taper, now at 4.5, and still experiencing the same stiffness and pain levels, but less frequently.
My theory is that I had mild osteoarthritis before experiencing PMR, and it was not noticeable because my normal cortisol production was keeping it under control. As I continue to taper, I am experiencing (and will continue to do so) a cortisol production shortfall while my adrenals struggle to increase production, and I therefore expect that the stiffness and mild pains will continue and are to be expected on occasion as the taper continues.
The message here is that pain during taper while on low levels of prednisone is not necessarily PMR pain. Although increasing your dose of prednisone would probably eliminate the pain, that approach should probably be avoided without doc agreement.

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@pb50

I don't think its a matter of something you're lacking. It seems to be more like a stuck switch. Your immune system begins to react to something - a virus or allergen or bacteria or such and something triggers that immune process to dial it up - and it doesn't get a signal to stop. So now your immune process is in overdrive and the mechanism to slow it down is stuck.
They don't understand fully what triggered that malfunction - but they have figured out how to stop and in many cases to prevent it - mostly.

Jump to this post

"Your immune system begins to react to something - a virus or allergen or bacteria or such and something triggers that immune process to dial it up - and it doesn't get a signal to stop. So now your immune process is in overdrive and the mechanism to slow it down is stuck."

I like this explanation! It sounds like reactive arthritis to me.

Endogenous cortisol from the adrenals is supposed to regulate inflammation ... not prednisone. Maybe the adrenals get overwhelmed by the excess amount of inflammation when the immune process goes into overdrive. Maybe the adrenals can't produce enough cortisol relative to the amount of inflammation. Prednisone works because it floods our body with exogenous synthetic cortisol.

Too much endogenous cortisol and exogenous synthetic cortisol causes an oversupply of corticosteroid. This causes a problem because too much corticosteroid is just as bad as not enough. If we persist with taking prednisone the adrenals take a holiday. The adrenals shut down the production of cortisol in an attempt to restore the proper amount corticosteroid.

The whole system that regulates inflammation (HPA axis) gets screwed up the longer we take prednisone. It isn't just inflammation that is regulated by the HPA axis --there are other things that become unregulated. My blood pressure and cholesterol levels went through the roof for example.

When the adrenals don't function, a major malfunction ensues.

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