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Is it PMR (and/) or Osteoarthritis?
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!
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The arthritis in my left hip flared when I was tapering off a low dose (10 mg) of prednisone for about a year. I ended up having a hip replacement at the end of the year. I did have a flareup of my PMR when I caught COVID and was taking 2 mg. at the time of my surgery. (BTW my PMR began after my second COVID vaccination). I have been pain free for a year now, but ocassionally I feel a little discomfort in my upper arms while in bed. I never had constant pain with my PMR--I only hurt while in bed and the pain was confined to my thighs and upper arms only. Hope this helps.
Thank you for your post, @dadcue. My rheumatologist has mentioned the possibility of taking a biologic (Kevzara), but my understanding is that the biologics lower a person’s immune response significantly. Was this true for you? Did you have to take special precautions when going out in public? If this is too personal a question, please say so. I just wonder how much taking a biologic might make my life even more restricted than it already is on prednisone.
This is my personal opinion but your question isn't too personal. It is a very good question!
Prednisone was restricting my life already so I wouldn't say my life is more restricted on Actemra. I had problems with prednisone combined with almost any other medication that suppressed my immune system. However, Actemra didn't seem to cause any additional problems for me.
Actemra allowed me to rapidly decrease my prednisone dose to 3 mg. Before starting Actemra, the lowest dose of prednisone I could ever maintain was 10 mg. My prednisone dose was usually much higher than 10 mg most of the time since I was diagnosed with PMR.
My opinion is that less prednisone suppresses my immune system less.
I'm not saying that Actemra doesn't cause problems with the immune system. My rheumatologist says I'm still immunocompromised. I still need to be careful but no more than when I was on higher doses of prednisone.
I have never tested positive for Covid. When I get a cold it resolves quickly. When I was on prednisone, some of my colds would linger for weeks. I haven't had any infection more than a cold since being on Actemra. Usually any infection would cause a flare but I don't have flares anymore.
There are warnings that serious infections can happen to people on any biologic. I wonder how many serious infections happen when people are on prednisone plus a biologic.
I'm currently on Actemra alone. I believe I'm at less risk now than when I was on prednisone.
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2 ReactionsThank you so much for your thorough and thoughtful answer. It is very helpful. Right now I seem to be stuck at 6.5 mg of prednisone. Going lower results in symptoms of PMR — not severe, but I don’t want a flare. Your answer makes me think that I should at least talk with my rheumatologist about a biologic.
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1 ReactionI have trouble determining if the pain I am experiencing in both shoulders is just my Arthritis or is it a PMR Flare up. This pain and some stiffness has become constant. I am a active 74 year old male and I know I have a lot of arthritis from my hips up to my neck. I was diagnosed with PMR about 5 years ago. Started out at 20 mg Prednisone and have had many flare ups through the years. My last inflammation markers were slightly above the normal range. I have been told that PMR always affects both shoulders and both hips. Anyone else have the same question - Arthritis or PMR ? Thanks
It doesn't have to be either arthritis or PMR. More likely than not it is arthritis and PMR.
PMR exacerbates wear and tear osteoarthritis. I'm sure there are other people like me who have been diagnosed with both inflammatory arthritis and PMR.
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2 ReactionsHi @greggview73, can you get an Xray of your shoulders?
My whole body ached constantly with PMR. I went to Physical Therapy before diagnosis, which didn't help. On prednisone my shoulder pain went away, but I never got full range of motion back in my right shoulder after going off it.
I've had rotator cuff and bicep problems for years in that shoulder and just found out, after Xray, I need a shoulder replacement, due to osteoarthritis.
I can get relief by doing some isometric exercises, squeezing the shoulder blades together, putting them down and back and using an infrared heating pad. Also, I've found the exercises in this video to be helpful:
https://duckduckgo.com/?q=Nathan+Shoulder+Arthritis+Presurgery+Exercises&atb=v314-1&t=chromentp&iax=videos&ia=videos&iai=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DtIbNvwbSDII
I had a steroid shot in the joint but it didn't help the tendon/bicep pain.
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2 ReactionsI knew I had issues with my left hip prior to the onset of PMR, but I kept it at bay for many years with an anti-inflammatory diet and exercise program. During my one year bout with PMR and weaning off of a low dose of prednisone, my hip exacerbated to the point that I had to have a hip replacement, which was the best thing I ever did. Anterior hip replacements are easy these days, whereas shoulders are probably not. I'm not sure if it was the PMR or the prednisone that made my hip worse, or perhaps I should just blame it on my mom, who had both hips done. 🙂 BTW, I only had PMR pain in my thighs and upper arms/shoulders and only when I was laying in bed! As soon as I got up in the morning, no pain! I do think that my whole foods, primarily plant-based, organic diet was a contributing factor in my mild case and fast recovery. I happen to be a registered dietitian. Good luck to you!
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1 ReactionHello @greggiew73 - I combined your discussion with an existing discussion titled, "Is it PMR (and/) or Osteoarthritis?" - https://connect.mayoclinic.org/discussion/is-it-pmr-and-or-osteoarthritis/ to meet the many members talking about a situation similar to yours.
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2 ReactionsHi. Hope you are doing well. I am wondering what biologic are you on? My ruehmy wants me to go on kevacrz. Thanks Ellen