Why is it so hard for doctors to distinguish if it's Rheumatoid Arthritis or PMR?

RA and PMR are totally different things, as far as I know.  RA is more to do with inflamation and bones, PMR with inflamation and muscles.  However, both are a beast.  The only good thing is PMR can go into total remission, but RA often cripples you for life (I believe).  The experts will put you right (and me, too, if I have misunderstood  something)!

 

Hello Leonard, I think Constance has it sort of right, and RA damages bones and this damage is visible whereas PMR doesn't. Pre diagnosis my GP told me that my blood had come back negative for RA? What that means I have no idea, but I assume RA can be diagnosed if certain markers show and likewise PMR is diagnosed if ESR/CRP levels are raised along with physical symptoms and relief to these symptoms when prescribed preds. Personally I would have thought a specialist/consultant rheumatologist would be able to tell the difference.

but to answer your confusion, yes one can have both conditions at the same time, and can be receiving different medication for each complaint. However, for you, you need to know ASAP so that the correct treatment plan can be started.

hopefully one of the experts will be along soon, to hopefully put us all right! Regards christina 

Hi Leaonard, I was diagnosed with RA 15 years ago, and the Malaria medication Plaquenil took care of it, and I was not bothered too many times wirh flares.  They only lasted 3 days, and they were gone.  I do not have any joint damage.

Last year in September I noticed different aches and pains which did not seem like RA flares.  My shoulders hurt and my back would hurt when I would sit down and get up for any length of time.  When I could not lift my arms over my head, I went to my GP and he said that I have PMR.  He put me on a higher amount of Prednisone 15 mg which helped my condition.

However, my rheumy doubted the diagnosis by my GP.  He still says I have RA and he says that 15 mg of Prednisone takes care of both ---- the "questionable PMR" and RA.

How come I have RA and absolutely NO joint damage???

I know for sure that I have PMR ---- I feel the PAIN!!

Thought to share my story.

 

I'm afraid I have to disagree with previous responses.

In rheumatology diagnoses are often not black and white.  It is easy to say a bone is broken - binary answer - yes / no.  In rheumatology we see a lot of shades of grey... diseases that start as one and become something else and diseases that sit between labels.

PMR like onset of RA is very well known particularly in the older population.

Furthermore, regards to the crippling comment - it's not something that is seen commonly these days.  There is also increasing evidence that very early & aggressive treatment for RA can basically 'cure' the disease.

It's partly because PMR is so difficult to diagnose with 100% certainty. I am one of the many diagnosed with PMR who are later found to have an inflammatory arthritis - mine is sero negative ie I dont have rheumatoid factors in my blood. 

To be fair to the doctors they were never completely convinced I had PMR as I didn't have classic symptoms. Though of course it is possible that I did have PMR initially which then induced inflammatory arthritis.

Of course I would rather have PMR as there is always hope that it will eventually go away - but even if it were rheumatoid arthritis that is definitely not any longer the automatically crippling disease it was once, thanks to the drugs that are now available.

Inflammations within the body tend not to come in ones! People with auto-immune illnesses often have several. For me, it is not the words (the diagnosis) that is important, or the test results (beware of the doctor who treats the blood test results and not the patient), but for me it is whether I can move from waking up with dread in my mind about facing the day with disablement, to welcoming the day with what it might hold for me in terms of recovery and living a life as normal as possible without needing to inconvenience others to care for me. BTW, there is a blood test for RA for what it is worth.

Late onset RA and PMR can both present with very similar symptoms and both will respond to pred - PMR does tend to respond faster and more completely to low doses such as 15mg. LORA tends to need a higher dose and/or the response is less dramatic. That is why the starting dose should be kept low and the response looked for is about 70% - if that doesn't happen then questions have to be asked about the diagnosis.

In the RA that happens in younger patients there can be evidence of damage to the joints - this is less common in LORA. You can have patients with RA who have what are called sero-negative or sero-positive blood tests - no straight answer. People with PMR can be either too. There is no 100% identifying blood test or symptoms - so confusion reigns. The "RA negative" means there is no rheumatoid factor to be found in the blood - but that does NOT mean you can't have RA, you can have sero-negative RA.

The "crippling" aspect is seen less these days because patients are treated with DMARDs, disease modifying anti-rheumatic drugs which prevent the joint damage - but patients who are not given them still develop joint damage.

And you can have both RA and PMR it would appear.