Finger joint pain - what's the prognosis?

Generally all the thigh, shoulder, hip and shoulder girdles pain and ache levels seem to be maintaining a fairly uniform and bearable background level that has allowed me to keep the taper going at this rate but like you  – one big issue that is really bothering me, and hasn’t followed the overall body pain reduction, are my HANDS.

The pain in the hands is not like carpel tunnel – it is in all joints of both hands from the wrist to the furthest finger joint. Both hands are almost locked up in the morning and need constant flexing (which is painful) to allow me to open the marmalade jar ! The flexibility and pain level does improve slightly toward the evening but is never gone completely.

I have researched and been informed that PMR has an influence on synovial fluid loss in the hand joints. Most info regarding synovial fluid irregularities is from patients with joint disease related to knee effusions and most medical research is largely limited to findings in the knee joint, but there is evidence that it can occur with PMR.

Regarding methotrexate (MTX) - my rheumatologist started me with MTX as well as pred after my first 'flare' and apart from this hand issue, I seem to be 'tapering' the pred quite well from 20mg to currently 4mg without any major issues. MTX (a DMARD) works as an addition ‘cover’ – OK for me but some others do not agree.

Hope all goes well for you and you make a good decision.

Dave

In looking back though it originally started in my back, I had back and shoulder pain at work.

Hope this helps.

It could also be late onset of RA in your case.  I have refused to take MTX.  I was on Plaquenil for a while, but did not make any difference because of PMR later on, and the prescribed dosage of Prednisone.would help both.

I like to take magnesium at night which helps the stiffness.

This is what I thought, and that this was called bursitis.  It seems to explain the exact nature of my range-of-motion issues in my hips and shoulders in particular, and extends to my ribcage area.

I have no problems with sustaining force using my muscles, other than when changing position, which to me distinguishes this bursitis from any sort of bone joint irritation.

There are other manifestations of pmr though.  I can't explain my thumb-joint flare-up as bursitis, but it does respond very well to small increases in pred dosage thankfully.  And the vasculitis which I believe causes headach during sleep seems to have no obvious connection to bursitis, unless perhaps vasculitis causes bursitis(???).

I keep my pred dosage at the absolute tolerable minimum, to where I can get a full night's sleep and to where my thumb can grasp things, and to where my localized hip bursitis doesn't flare abruptly. So I am constantly having to make small adjustments to my pred dosage, to keep each sort of symptom from causing real grief.

When I can get generous daily exercise (morning exercise seems to work best) is when I have consistently been able to make downward adjustments to my dosage and get away with it.

Your joint stiffness reminds me of my severe finger/wrist/elbow stiffness that resulted from wrist injury-induced CRPS (complex regional pain syndrome). I didn't have any prednisone around at the time to try, but my doctor suggested a nervous system drug call Lyrica, which I chose to do without, and I did manage to recover almost entirely after about six months.

Finger pain like this can and does happen in PMR but usually at the outset and fades eventually with the pred as the inflammation is managed. It is synovitis and tendonitis - not bursitis: inflammation of synovial tissue and tendons and not bursae. Semantics to some extent, it's all inflammation!  Mine took several months of pred at above 10mg to fade but has never returned other than the odd painful stab when I bend a finger "wrong" which I think everyone gets at some point in advancing age!

If 20mg isn't managing it, if it is getting worse, then you need some other investigations and possibly other forms of treatment. I hear the discussion about "Is this OA, is this RA" over and over on the forums - there are many forms of arthritis and connective tissue disorders and while the primary difference between, say, PMR and RA is the erosion or not of the joints, other forms of arthritis manifest in different ways and erosion may not be seen for some considerable time of non-management.

So without knowing what this finger pain is due to it is impossible to answer any of those questions. It depends what it is as to whether there will be long term damage. It depends what it is as to whether methotrexate will help - even in RA it doesn't work for everyone or it works for a while and then the effect fades, requiring a switch to another medication. Should you be upping the pred dose? Probably not - not without a far better idea of what is going on. It is possible that other therapeutic measures may help - warmth, support and physio for example.

As I said to start with - what you should be doing is looking for another opinion. Otherwise whatever you do is a mere stab in the dark - which may or may not make a difference for better or worse.