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PMR or RA?

Posted , 6 users are following.

k8211
k8211

I was diagnosed one month ago with PMR after having symptoms and problems for 9 months.  Extreme stiffness in hips/thighs and later it developed in my shoulders and upper arms.  Also had swelling in my hands, wrists, feet and ankles as well as pain in knees and elbows and lower back.  Started prednisone of 20 mg a month ago and will continue with that dosage for 3 months before I start to taper.  However, at appointment yesterday, my specialist is now questioning whether it is PMR or RA.  He said that while the prednisone has dramatically improved my symptoms, he feels I am having some atypical symptoms of PMR - mainly hand and feet swelling as well as other joints not usually involved in PMR.  Because of this and because of my age (50 years old), he is doing further testing for RA to make sure the diagnosis is right. I have previously been tested for RF and it was negative.  He also said that even if it is RA, the prednisone would also have improved symptoms for RA as well.  Never realized how difficult it would be to get a clear diagnosis.  I have been having problems for 10 months now.

0 likes, 5 replies

5 Replies

  • Danrower
    Danrower k8211

    Posted

    I had my first bout of PMR @ 53, and had identical symptoms as yours. Undiagnosed, got better after 12 months.

    came back with a vengance @ 63, and lasted for 18 months. Mayo clinic said "not convinced that it is  PMR cause of the involvement of hands, wrists, ankles and feet. could be late onset RA. (LORA)

    Me thinks the medical training is inaccurate.

    Me thinks I have PMR.

    Me thinks you too.

  • constance.de
    constance.de k8211

    Posted

    Me thinks as Danrower, too!

    My hands, ankles and also feet have been swollen since the beginning of PMR (almost 5 years ago)!!

    I think you should look up a few other posts on this site.  The signs you mention often come up.

    Good luck with your diagnosis.

  • EileenH
    EileenH k8211

    Posted

    There is no clear differentiation of PMR and RA presenting with PMR symptoms. There is no definitive test for either - even rheumatoid factor can be negative in someone with RA and positive in someone who is perfectly healthy!

    However - hands and feet CAN  be involved in PMR. The leeds rheumatology group had a look and decided, yes, the patients who said they had hands and feet involvement were right enough. I had pain both hands and feet and a lot of people on the forums describe the foot pain as feeling as if you are walking on sharp pebbles mixed with broken glass! Mine improved a bit after about 10 mins walking but getting up to standing after sitting for even 10-15 mins was excruciating. I had sharp stabbing pains in my hands - probably tenosynovitis - which also went up my forearm as far as my elbow. This lot took about 5 or 6 months to fade after going on pred.

    My feet were swollen - I needed a size larger in shoes! I can't remeber of my hands were swollen - but I imagine they were as I ended up needing a larger size in rubber gloves - although the small size is pretty borderline.

    I've had it for 12 years and there is nothing to suggest that I have LORA. No joint pain at all even when I got down to 5mg. No-one disputes my diagnosis of PMR (except the second rheumy I saw who wanted it to be ANYTHING except PMR. They all too often don't seem to feel it merits their notice ...

    • k8211
      k8211 EileenH

      Posted

      Thanks Eileen. While the prednisone is taking care of all my stiffness, my hands are still swollen. They are probably 50 percent better than before prednisone. Still have minor aches in hips, knees and lower back. The stiffness was the worst part for me so I am happy that it is gone. What would I be looking for in the event my condition is RA and not PMR?
    • EileenH
      EileenH k8211

      Posted

      Don't really know - my special subject is PMR! I think the only real confirmation comes when there is x-ray evidence of joint damage and I think that doesn't always happen in LORA, or not until pretty late. It took several months of 15mg pred for the hand and foot problems to go for me. 

      I suspect you will have to go with the rheumy - and bear in mind that 1 in 6 PMR patients ends up getting a revised diagnosis at some later point. Often, but not always, LORA.

      However - although many rheumies try using methotrexate along with pred for PMR, it works for very few on its own, if it does I suspect that the diagnosis should have been LORA and mtx is the first line drug. So if he tries to get you to stop pred and take methotrexate you may have to try it.

      But you haven't got there yet.

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