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PMR or Rheumatoid Arthritis??

Posted , 14 users are following.

connie08789
connie08789

I was just wondering if anyone else had been diagnoised with PMR and then been told it has possibly moved into Rheumatoid Arthritis.  It's been four months since I was diagnoised with PMR by my Rheumatologist on November 24, 2014.

To recap: I had all the classic symptoms of PMR the end of September, 2014 with shoulder pain and stiffness, couldn't raise my arms over my head, took two hands to hold a cup of tea, severe pain and stiffness in the backs of my legs to the point I couldn't sit, could barely walk at times or get up from a sitting position, or out of bed, etc. and the only thing that helped was prednisone. I went through tons of labs and blood work, x-rays, worked with my internist, saw a neurologist, and finally the rheumatologist in November 2014 which resulted in the diagnosis.  I was put on four infusions of prednisone in December, then started at 20 mg. daily of prednisone and 10 mg, of methotrexate.

I'm currently at 12&1/2 mg. of prednisone and 20 mg. of methotrexate daily and doing really well at the moment with the pain and stiffness gone for now and only dealing with the fatigue. At my check up with the Rheumatologist on Monday she told me that she thought due to the lab work, etc.in late February she felt that I was really leaning more to Rheumatoid Arthritis than PMR. I see her again in two months when they will do more blood work. I  just wondered if this had happened to anyone else here.  Any information about the differences in the two, deciding factors for diagnosis, etc. will be greatly appreciated.  I know nothing about RA and was just starting to somewhat understand PMR.  I was tested for RA in the early testing last October, but no positive results at that time.

Thanks for your help!!

 

2 likes, 27 replies

27 Replies

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  • paula63201
    paula63201 connie08789

    Posted

    I didn't think RA responds to Prednisone.

    I am no expert, but RA is very different. My Mom had it, and she had bad flares that resulted in deformation of joints, redness of joints, etc. She was given Metotrexate for the RA. 

    I was tested for RA before I was diagnosed with PMR and that came back negative (twice). The PMR diagnosis was confirmed when all my symptoms disappeared when I took the 20 mg of Prednisone in December 2013. Now on 6.5 mg moving to 6: still no symptoms, thankfully.

  • Juno-Irl-Dub
    Juno-Irl-Dub connie08789

    Posted

    HI CONNIE, Did you make a mistake when you said you were taking 20mg. Pred. daily and 20mg. methotrexate DAILY?. My understanding is that MTX should ONLY  be taken once per week - no matter what the dose. Please check your MTX box for the instructions. This is important. Or call your pharmacist. Keep in touch.
    • connie08789
      connie08789 Juno-Irl-Dub

      Posted

      Yes, I goofed!  I take the methotrexate 20mg. only one time a week and the prednisone daily.  I realized the error but you can't go back and edit once posted. Thanks for pointing  the error out.  I'm sure others  questioned my dosage.
    • EileenH
      EileenH connie08789

      Posted

      We have asked for editing options - no joy yet.

      If you want a post changed or deleted you can report it to the moderator who wll do it for you.

    • Juno-Irl-Dub
      Juno-Irl-Dub connie08789

      Posted

      Thank God for that, I thought you were heading for real trouble there!!  I hope you get the RA issue sorted out shortly. Very best wishes - and thoughts.
  • EileenH
    EileenH connie08789

    Posted

    About 1 in 6 patients who are given a dx of PMR to start with later have it revised to something else, very often late (or elderly) onset RA. 

    There aren't really any 100% certain ways of distinguishing between PMR and LORA. Rheumatoid factor can be positive or negative in either and their symptoms can be very similar. 

    In some ways PMR and RA are very similar in symptoms and LORA often does not have any joint damage either. The positive of RA is probably that there is a range of drugs that can be tried, most of which have fewer side effects, whereas PMR only responds to pred with all its attendant disadvantages.

    But do ask her for her justification for an RA rather than pred dx. She must have seen something in the bloods - but without knowing what it is difficult to comment.

    • connie08789
      connie08789 EileenH

      Posted

      Thanks, Eileen!  I didn't get to talk to the rheumatologist as I wanted to about this.  She was called to an emergency phone call before we got further with the discussion on why the sudden change in diagnosis. The nurse said they would know more with the next blood draw in two months.   BTW!  I goofed in my first post, and I take the methotrexate 20 mg. just once a week.  The prednisone is daily.
  • tina-uk_cwall
    tina-uk_cwall connie08789

    Posted

    Hello connie, what confusion? I understand that some PMR patients are later diagnosed with RA. However, I agree with Paula other than to say that a lady I know that has RA only takes mtx as a rule but is prescribed a short course of preds when she has a flare. Hope you find the answer so so that you can make some sort of sense of what you are going through. All the best, christina 
  • betty75074
    betty75074 connie08789

    Posted

    Hi connie my results were not positive today for Polymyalga so I have to have further tests in 4 week again for a full body blood test so wondering myself if I could have RA as my symptoms are similar to my friend who has suffered for many years with RA. Having had Polymyalgia 5 years ago and 3 years with not many symptoms I had a flare up a few weeks ago but it got so bad I just needed the doctor to prescribe Pred. I am on 8 x5mg (40) even in the past 3 days after Pred. my pain is really not bad at all so like yourself I need to wait on results. At least you know others are in a similar position.
    • MrsO-UK_Surrey
      MrsO-UK_Surrey betty75074

      Posted

      Betty, that is an unnecessarily high dose of Pred for a diagnosis of PMR.  15mg is the recommended starting dose, with 20mg occasionally being prescribed.  Prescribing as high a dose as 40mg for PMR is putting someone at unnecessary risk of side effects.  That dose is usually reserved for those diagnosed with the linked condition, GCA.
    • EileenH
      EileenH betty75074

      Posted

      There are no "positive" tests for PMR. I assume you mean the blood tests ESR and CRP - which can be normal in 1 in 5 patients with PMR. The diagnosis of PMR should be on the basis of a clinical examination and symptoms with the typical sites of pain and stiffness - the blood tests that show inflammation are only one piece in the jigsaw. 

      As MrsO says, that is a very high dose for suspected PMR - it is the normal starting dose for suspected GCA where it is needed. PMR responds to a moderate dose and that is one of the criteria in diagnosis - dramatic response to a dose of 15-20mg within 2 to 3 days. A lot of other things will respond to such a high dose.

    • betty75074
      betty75074 EileenH

      Posted

      Sorry Eileen I have lost my text back to you, it just went!! Thank you for reply, I did notice ESR and CRP on blood form and doc did say trigger points would be tested but does doc do this after being diagnosed, I am confused as last time I just took the tablets and hoped for the best having relief for about 3 years and an occasional flare up which Ipobrufen worked but of course not this time. This group discussion has opened my mind more to just what pain I am having, everyone seems so knowledgable re these conditions. Thanks again.

       

    • EileenH
      EileenH betty75074

      Posted

      If he mentioned trigger spots it sounds as if he thinks it may be fibromyalgia rather than PMR - there are a lot of similarities in some ways but the primary difference is that PMR responds well to 15-20mg of pred, fibro pain doesn't respond to pred.

      How has this massive dose of pred worked? Has your pain improved by a lot since you started taking it? At 15mg they look for a 70% improvement in all symptoms within a few days that then returns in a similar time frame if you stop taking pred. Not sure if 40mg should do more - I suppose it should. But whatever dose, there is often some residual pain, you aren't pain-free.

      We seem to know so much more than you because we've had PMR/GCA a long time and have made it our business to know so we can provide support for others. I just do stuff online and write articles for neslatters. MrsO runs a superb support group in Surrey - with fantastic guest speakers so she has learnt an awful lot over the last few years!

    • betty75074
      betty75074 EileenH

      Posted

      thank you Ellen like you say the people who have these pains know what others are suffering. Re Fibromyalgia  this is 4th day of 40mg pres. and I am almost pain free at this moment as this is the way it worked for me before, relief so quick it was like a miracle for me as at that time I could not get out of bed without my husband pulling me, taps and door handles was so painful along with the frozen shoulders and upper arm pain, I was so grateful to be pain free for a long time after that and thought It would nevr return, of course similar is back perhaps not so bad! I blamed being bitten 13 times overnight in Italy with whatever insects or mosquitoes, what a mess I was in on that first day of holiday and all these symptoms started within a couple of days when back home, but who knows Ellen? I thank you for all the info and am taking it all on board, not ruling out Fibromyalgia either I am so glad to have found this forum with folk like yourself full of information, I live in Scotland so weather here can also be a big factor for a lot of us with the dampness. Will keep looking for info.
    • betty75074
      betty75074 EileenH

      Posted

      Thank you Eileen I will log into it now, your info is just great and a real help. I am North of  Glasgow North Lanarkshire.
    • EileenH
      EileenH betty75074

      Posted

      One of the helpline ladies is from Alexandria (I think), Sarah, she was a nurse at Robin House, but I can't remember her surname.
    • betty75074
      betty75074 MrsO-UK_Surrey

      Posted

      Hi Mrs O and Eileen for info re Scottish forum am going to go for the Scottish one and have a look, thanks for all your help will be back and let you know how I get on.
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