Originally diagnosed with pmr put on steriods 20mg since January 17th and feeling great. Nl

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Saw rheumatologist on Feb 27th and diagnosis is. now rheumatoid arthritis since I did not have elevated sed rate, she wants me to start on methotrexate 2.5 mg 4 tabs weekly for 2 weeks, then 5 tabs once a week for 2 weeks, the 6 tabs x 2 weeks, then finally 7 tabs once a week. Says it can take 2-3 months to notice any change, and wean prednisone as tolerated. Looking for advice and feedback. Thanks.

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6 Replies

  • Posted

    Of course many people with PMR do not have raised inflammatory markers.  Do you have some of the symptoms of RA? 
  • Posted

    My rheumatologist said to me that she thinks maybe I have RA even though I don't have any markers for it.

    I do however have markers for PMR. And she is treating me for that. But she just can't believe that all my pain comes from the PMR. She just keeps thinking that some of my pain has to be from RA. Yet I have no inflammation in my joints.

    So I think rheumatologist get it wrong all the time.

    • Posted

      Plenty of us on here could bear witness to the unbelievable pain of PMR but I don't know any way to communicate that to someone who has not experienced it.

      I have two neighbours/friends I can ask about their RA symptoms and diagnoses but individual differences always come into it, too, of course.

    • Posted

      Here is what my neighbour has just sent me. As you will see, she has had RA for many years.

      Betty, the markers for RA are complicated. To get the diagnosis one has to have 6 out of 8 possible ones whish include; weight loss, symmetry of symptoms, Rh factor in blood and others. Well it was 6 out 8 20 years ago when I got the diagnosis.  It can take years to acquire the necessary number of markers and therefore get a diagnosis.  'inflammatory arthritis' or 'palindromic arthritis' are often use as holding diagnoses - broader categories into which RA fits.

      NRAS is the place to go. http://www.nras.org.uk/making-a-diagnosis-of-rheumatoid-arthritis  They have a very good phone help line and deal specifically with RA.

      Personally I would refuse methotrexate as a long term treatment, but nowadays it is offered as first line treatment as it is also of use diagnostically as other Arthritis conditions do not respond to it.

      I have been on MTX (methotrexate) but asked to come off. It did nothing for my moods.  I've been very fortunate in that anti-inflammatories and a drug called Sulfasalazine work for me with no side effects.

      If it's any comfort, getting the diagnosis is by far the worst time of living with the disease…. most pain, least effective medication, least care and information.

      Don't know if that is any use to you.  

  • Posted

    Up to 20% of patients have normal markers. If it is PMR then the mtx may or may not make a difference - for some people it helps them manage on a lower dose of pred, for many it doesn't or does so only for a time. There is no reliable proof it helps and the advice is it should be used in a shared decision with the patient - yeah, right, that's going to happen with a lot of rheumies! It may only add another layer of side effects.

    But if she is convinced it is RA (with no more evidence than she has that it is not PMR) I doubt you will persuade her otherwise. I have taken the view that if you have no side effects it is probably worth trying in PMR - I suppose that remains my attitude. But I wouldn't accept it if it made me ill.

  • Posted

    My Rheumy took me down the very same path.  Precisely.  No blood markers for PMR and some inflammation in my hands which led him to suspect LORA. I followed the Methotrexate protocol and felt zero improvement after many weeks.  Then I read about the many side effects of Methotrexate including potential for liver damage, and I shut it down the very next day. 

    I suppose its its worth a try for you as you may have a form of RA or what my Rheumy still thinks could be some other form of inflammatory arthritis. Sadly, my conclusion about all of this is that rheumatology is still in the Stone Age and many of these guys are still guessing.

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