PMR and PsA

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Anyone dealing with both of these?   Concerned about new medication 

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  • Posted

    My bad!  I’m a 51 year old female.   After many years of back and knee pain, I was finally referred to an osteopath.  After X-ray and MRI s it was determined that I had arthritis.  Finally getting into a rheumatologist, and diagnosed with PMR, I’ve been on prednisone.  And trying to taper down from 30 to 10.  Under 10 I have horrible pain and have problems getting out of bed.  My visit yesterday showed that my C-reactive protein had doubled to 27.  I was then upped my dose of prednisone to 15mg.

    I reminded him that I also suffer from psoriasis and have had badly swollen ankles that I was able to show him photos of.  Now, he thinks I may also have PsA.... an autoimmune disease associated with psoriasis/. A rash that affects knees and elbows, and may reach the scalp.  One of the treatments is a medication called “methotrexate “.  The side effects seem bad.   Anyone experiencing PMR and PsA??? Thanks

    • Posted

      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.

       

    • Posted

      Thanks Eileen

      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.

    • Posted

      Okay, one more thing...

      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?  

    • Posted

      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.

    • Posted

      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.

    • Posted

      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 .  

    • Posted

      I appreciate your knowledge.. really hope that you’re a medical professional, and not that you know all of this first hand
    • Posted

      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?

    • Posted

      Aha... don’t know you age when you were diagnosed with PMR.   Probably under 50?  Therefore that was looked over as a possibliity?   I cried in my primary doctors office so many times, they didn’t know what to do with me.  Been going there for 20

      Years.   So humiliating and frustrating.

    • Posted

      And even though we sign every paper, so that doctors can communicate and share information, fill out a ton of paperwork.....  if I hadn’t taken photos of my scary psoriasis and swollen feet, this wouldn’t be a concern now.  
    • Posted

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

    • Posted

      In case y’all on the east coast .... good luck!  Will be praying for ya!
    • Posted

      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.

    • Posted

      So glad that we have come so far since your initial diagnosis!!!!!! After the orthopedic sent me awaysad 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!

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