PMR and PsA

You will find more people on here with experience of methotrexate than you will who have both PMR and PsA. Some rheumatologists think that using methotrexate will help patients get to a lower dose or even off pred (not necessarily the case at all) so quite a few on the forums have tried it. I have - for 4 weeks but found the side effects unacceptable. Or at least, unacceptable enough for me to say I wasn't prepared to find out if it would get me to a lower dose of pred! I have no problems with pred at all so why mess it up.

However - despite my personal experience with mtx I think it is often worth trying because many people do take it without any problems at all since it is the firstline approach for rheumatoid arthritis.

It is actually quite likely you don't have both - but that the PMR-type symptoms were due to the PsA. It should be part of the differential diagnosis to ask if there is a history of psoriasis. My rheumy was desperate to make my PMR anything besides - including PsA.

I thank you for all of the information you gave me months ago re PMR.... and the articles on how prednisone isn’t the evilness that we’ve been told.  PMR was unusual because of my age (51), however the prednisone worked so well I figured I had the proper diagnosis.  And after tell my doc about the psoriasis, and swelling; he came up with PsA. Which I asked what’s worse.  Just wanna know what else I’m in for!!  So at 15 prednisone... get blood work for hepatitis before mex.  does that sound appropriate procedure?  One post suggested I get on it ASAP.  

Thankfully for everyone’s experience and knowledge.    Seems like a vicious drug.

My understanding was that PsA is “worse” than PMR... regarding prognosis and treatment.  ????   The symptoms of both seem upper body vs lower body ( I know that’s way to simplistic).... but the foot and wrist pain have been my most recent probs.    Maybe pre existing issues?  

As someone said on the other forum - many people take it with no problems at all. OTOH, about 1 in 3 have to stop because they find the side effects intolerable. The only way to find which you are is to try it - and it can be stopped immediately if you can't tolerate it. You do need to be monitored regularly for liver problems - but it is not so much hep as the effect mtx can have on the liver. If it raises your liver enzymes you will be taken off it. Most doctors now allow a small amount of alcohol - I was only on it a month and didn't change my drinking habits but my liver markers were fine. I had no nausea but apparently splitting the mtx dose and taking half before bed and half the next morning helps that. If nausea is a problem there are injections that avoid that. 

Which is worse? I suppose it depends how you look at it. There is no cure for either but they can be managed pretty well. The only option for PMR is pred but it mostly eventually goes into remission on its own and may not reoccur - which means you can get off medication. PsA on the other hand is like all inflammatory arthritides, it rarely goes into remission BUT there is a much wider range of drugs that work to manage it including biologics which seem to be a real gamechanger.

PsA is "worse" in that it doesn't usually go into remission as PMR does for 95% of patients and it can also cause joint damage which PMR doesn't. The foot and wrist pain may be the advancing PsA - you have probably had it for ages but it doesn't always cause joint problems to start with.

Yep.  My phlebotomist can’t take a m of prednisone.  Who knows, this new stuff may be my new best friend.  So of course I’ll give it a try.  What, am I possibly gonna feel worse?  Oops, never say that😜...   okay, I think u may think this is funny ( I really don’t want to get thrown off this chat),   A comedian said “. On prescriptions, that warn of liver complications.... please show a little man with his heart exploding,  or me having a very creative, fun time”.    Yep , I’m super Inappropriate.   So I guess I’ll do what the professionals say,  then text about my issues to y’all.   I’m a novice .  

i have a physiology degree (changed my mind from medicine) and also worked in the NHS as well as doing medical translation for many years. You have to have a broad background knowledge. I developed PMR 14 years ago and found this forum ver 9 years ago when I had finally worked out for myself what I had - the doctors didn't! Then I became involved with the charities and PMR became my specialist subject. So the broad medical knowledge became more specialised - it's all stuff that is relevant to patients with a PMR diagnosis. You should have been asked originally if you had psoriasis - amongst a load of other questions. A full clinical history seems beyond a lot of doctors these days. Or they ignore what you tell them - after all, what can a patient know?

Years.   So humiliating and frustrating.

I now ask for multiple copies of blood work, so that I can give them to whatever dr I’m seeing 😐

I was still 51 when it started and 57 (just) when it got a name. The GP hadn't a clue - my bloods were always "normal" so there couldn't be anything wrong apparently! I had also seen a rheumy about hand pain - she informed me I had OA and that was also causing the knee pain. The OA diagnosis was a . bend of the knee and "OA - I can feel it..." . Well,  13 years later that same knee has no sign of OA even on an x-ray! The bloods maybe were normal range - but not normal for me. Not the same thing at all.

So glad that we have come so far since your initial diagnosis!!!!!! After the orthopedic sent me away X-ray and mri on my knee showed arthritis ),  went back to GP.  (I have blood work every 3 mos for thyroid... )new panel of tests for inflammation/connective tissues, autoantibodies stuff.  Everything fine!  

Must be psychosomatic 🤨. 

Rheumatologist only ever wants C-reactive and sed rawest .  Don’t show him anything else!!  And I absolutely filled out the novel of my life... surgery, medications,  breastfeeding etc.    

As quickly as I was diagnosed with PMR, it’s possibly something else, or in addition to.  Although ya don’t tyits probably both.  Continuing to read up on prednisone.  As it continues to alleviate my pain, and have no sleeping issues 🤗

Have a great weekend!