Is it PMR (and/) or Osteoarthritis?

Posted by walkamok @walkamok, Jun 8, 2023

My encounter with PMR began in November 2022, when suddenly I was beset with the pain and stiffness you are all familiar with. Even rolling over in bed required a fully-developed plan implemented with gritted teeth. Climbing the stairs was done on all fours. After a couple of weeks the diagnosis was made and a hefty dose of prednisone was started. This med was almost cartoonishly effective. Now I am on a taper like everybody else here!
Anyway, for months I have been bumping my way down the taper (presently a split dose of 6 and 3), with a pain level of 1 to 1.5 fairly consistent, and with a rare 2 or 2.5 usually associated with strenuous labor. However, ever since beginning the prednisone I have had no symptoms in my upper body; they are all located in the hip area. Furthermore, the symptoms are all located in the groin area, say, inboard of the hip flexors. OK, near my tackle. I have zero symptoms outside the groin area.
I know that osteoarthritis is lurking as it was identified in a hip x-ray taken when this all first hit, but the arthritis had been asymptomatic. But I am wondering now if in fact the PMR is being fully controlled by the steroid and all felt pain is actually associated with the arthritis. If so, perhaps I should stop hand-splitting firewood and speed up the taper.
Could you please weigh in on the following questions?
1. Do you have symptoms in your upper body/shoulders?
2. Precisely where are your middle-of-body symptoms located?

Many, many thanks!

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

It is incredible to me how good my shoulders and arms are in spite of all the severe pain in that part of my body when I was diagnosed with PMR.

My mid section down can only be described as a disaster zone. That part of my body wasn't so good before PMR was diagnosed.

I had a very long 12 year history of PMR. My original presenting systems of PMR were almost entirely my neck, shoulders and arms. I was begging for prednisone because of an even longer history of inflammatory arthritis which seemed to attack my spine and knees the most. Inflammatory arthritis was associated with uveitis which attacked my left eye mostly. I lived in fear of a day when I wouldn't have access to prednisone and that day arrived in the form of PMR. The pain had a way of spreading everywhere.

I have never heard of prednisone being described as "cartoonishly effective" but that was how it worked for me. One dose was sometimes all it took and I was "cured" of inflammatory arthritis. I usually took about 40 mg more or less for inflammtory arthritis. Fortunately a wise rheumatologist could discern that something different was happening that suggested PMR instead of inflammatory arthritis. When PMR was diagnosed, I got to take less prednisone but on a long term basis.

There really wasn't that much difference in the pain I felt with inflammatory arthritis as compared with PMR. The main difference was inflammatory arthritis was acute onset like overnight whereas PMR and PMR flares were more gradual over a few weeks and continued to get worse unless I took more prednisone. I was also "old enough" to have PMR whereas I was much younger when inflammatory arthritis started.

How long PMR and the need for prednisone lasts is anyone's guess. There are better treatments than prednisone for inflammatory arthritis. My understanding is that prednisone doesn't prevent the damage caused by inflammatory arthritis. I took prednisone for PMR for a very long time. Now I seem to have an inordinate amount of arthritis in my spine, knees and pretty much from the waist down.

I challenged my rheumatologist on more than one occasion about whether I still needed prednisone for PMR. She reassured me that my primary diagnoses was PMR but I still had inflammatory arthritis.

I'm off prednisone now thanks to a biologic targeted at PMR. The biologic was originally developed for rheumatoid arthritis but that isn't the type of inflammatory arthritis that I have. The hope was that the biologic would help both PMR and inflammatory arthritis. It is quite possible and more likely to have more than one autoimmune condition. Unfortunately when prednisone is used to treat PMR, arthritis can still occur and get worse.

The moral of this story is that prednisone taken by PMR sufferers doesn't prevent arthritis from becoming worse.

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Thanks for your helpful response. That is a long road you have been traveling. I wish you the best.

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A wealth of information for me, newly diagnosed. Thank you for sharing.

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Your mention of groin pain reminded me of my husband’s Orthopedic Surgeon’s comment. When groin pain is present it indicates trouble in the hip joint. My husband has had both hip joints replaced. Getting old isn’t for sissies!

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I was diagnosed in April and my symptoms were overwhelmingly in my upper arms down through my hands and fingers plus my knees. I had a little soreness where I flexed my hips which I initially attributed to compensating for other areas but it immediately went away when I started prednisone and my rheumatologist said it was pmr. I totally relate to your battle plan for getting out of bed and doing so with gritted teeth which I also needed to do to rise from a sitting position. To climb stairs I had to tell myself, “now lift that leg.” I am making good progress and now back to doing most things with some limitations and do not want to go back to acute pmr phase where not only was the pain a 10 plus but the mental exhaustion from having to think thru every move was overwhelming.

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Thank you for this input. It seems as though PMR cases are as notable for their dissimilarities as for their similarities. My best to you!

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Night and early am leg pain. Md said increase prednisone back to 10 mg. Had tapered to 6 mg. Had quit statins thought it was cause of leg pains. Now ok with prednisone increase. Thinking of trying statins again. Anyone had experience with this?

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@dadcue

It is incredible to me how good my shoulders and arms are in spite of all the severe pain in that part of my body when I was diagnosed with PMR.

My mid section down can only be described as a disaster zone. That part of my body wasn't so good before PMR was diagnosed.

I had a very long 12 year history of PMR. My original presenting systems of PMR were almost entirely my neck, shoulders and arms. I was begging for prednisone because of an even longer history of inflammatory arthritis which seemed to attack my spine and knees the most. Inflammatory arthritis was associated with uveitis which attacked my left eye mostly. I lived in fear of a day when I wouldn't have access to prednisone and that day arrived in the form of PMR. The pain had a way of spreading everywhere.

I have never heard of prednisone being described as "cartoonishly effective" but that was how it worked for me. One dose was sometimes all it took and I was "cured" of inflammatory arthritis. I usually took about 40 mg more or less for inflammtory arthritis. Fortunately a wise rheumatologist could discern that something different was happening that suggested PMR instead of inflammatory arthritis. When PMR was diagnosed, I got to take less prednisone but on a long term basis.

There really wasn't that much difference in the pain I felt with inflammatory arthritis as compared with PMR. The main difference was inflammatory arthritis was acute onset like overnight whereas PMR and PMR flares were more gradual over a few weeks and continued to get worse unless I took more prednisone. I was also "old enough" to have PMR whereas I was much younger when inflammatory arthritis started.

How long PMR and the need for prednisone lasts is anyone's guess. There are better treatments than prednisone for inflammatory arthritis. My understanding is that prednisone doesn't prevent the damage caused by inflammatory arthritis. I took prednisone for PMR for a very long time. Now I seem to have an inordinate amount of arthritis in my spine, knees and pretty much from the waist down.

I challenged my rheumatologist on more than one occasion about whether I still needed prednisone for PMR. She reassured me that my primary diagnoses was PMR but I still had inflammatory arthritis.

I'm off prednisone now thanks to a biologic targeted at PMR. The biologic was originally developed for rheumatoid arthritis but that isn't the type of inflammatory arthritis that I have. The hope was that the biologic would help both PMR and inflammatory arthritis. It is quite possible and more likely to have more than one autoimmune condition. Unfortunately when prednisone is used to treat PMR, arthritis can still occur and get worse.

The moral of this story is that prednisone taken by PMR sufferers doesn't prevent arthritis from becoming worse.

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I am experiencing pain in my spine, ribs 7 & 8 fractured, 7 healed, pain due to fractures in vertebrae, autoimmune diseases, CAD, Heart Failure, anemia and Hyperparathyroid. Medication list is extensive but to answer the steroid use question, no, this does not help the pain and I have been on Plaquenil for years. Recently suggestion to do injections into spine. Not doable in view of my blood thinner use.

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I was diagnosed the end of May and have been on 2 weeks of 15mg per day of prednisone and now 12.5 daily. At the time I was diagnosed, I couldn't turn over in bed without crying out or walk without assistance. The had pain started the back of my neck and slowly moved down, shoulders, lower back and legs. The oddest thing was upon laying down, I was unable to lift either leg up off the bed. I think that's called the hip girdle causing it.
I now have some breakthrough pain but hope that goes away in the days to come.

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@1942marilyne

Night and early am leg pain. Md said increase prednisone back to 10 mg. Had tapered to 6 mg. Had quit statins thought it was cause of leg pains. Now ok with prednisone increase. Thinking of trying statins again. Anyone had experience with this?

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I have taken atorvastatin for probably 10 years, and still do even though on prednisone. So far so good.

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