Pmr/ra

Hi I am 57 around March time last year I visited gp 3 weeks in a row with shoulder ache/pain which seemed to be more muscular than joint - eventually prescribed prednisolone 20 mg which was reduced to 10 mg after one week then 5mg which I have been on since - however over the last few months experiencing terrible pain in wrists hands and less frequently feet - doc says this is related and on last visit suggest reducing prednisolone- whilst saying the object was not to be in pain I am wondeRing is this pmr /ra or both afraid to reduce in casE other symptoms return but wondering if this is appropriate treatment if also r/a . I am wondering if anyone else has been through this dilemma and can advise -thankyou ps to those of you on pmr site sorry to be a bore and repetitive

[Angela123]

Hi Sue. I'm 61, diagnosed with RA in May 2013 and had my first Polylyalgic flare in December 2013. I think we are in such a difficult position, because our symptoms can overlap, for instance my fingers ache this morning. That's a symptom of both conditions, although I don't have any swelling as such. My left hip has been sore to lie on during the night - PMR? RA? Or osteoarthritis which I also have in various places. My Rheumy seems to deal with my symptoms rather than calling them by name. I'm at 5mgs Prednisolone after 13 months of Pred, and I take 15mgs MTX for my RA which is in my hands and feet and seems to be well controlled. But there's a possibility that might be increased at my next appointment in order to try and get the Pred down further. I've been at 5mgs since last August and not pain free by any means, so I've had a couple of Medrol injections to see me through along the way. I also have the wrist pain that you have and in my feet. You are exactly the same as me in that your Rheumy talks about Pred reduction while you still have pain. Sometimes I wonder if he really thinks I don't have PMR, and it's all RA related, but I never actually ask him because as I say, he seems to treat it all as a whole. But on my blood test forms he only mentions RA and MTX. You are not a bore or repetitive, you are trying to get a better understanding of what's going on in your body and so am I! The trouble is, I suspect we are too 'British' and too polite to ask our doctors outright, or challenge their treatment. It's also possible that our doctors don't actually have all the answers themselves of course. I have a blood test on Monday and see him again mid-February, so we'll see what happens next. Good luck and keep in touch. Angela x

[Hidden in reply to Angela123]

Thankyou for your very understanding response we do seem to have similar presentations and though it's rubbish it's good to be able to relate to people . You are right about being "British"-I walk into the doctors surgery feeling like a nuisance ( that's down to me not them at all) and I feel so frustrated and cross with myself when struggling which I know isn't reasonable but difficult to change! .

I plan to go back to go after reading all advice and will ask for referral as I do feel I need to know what is going on and a more structured treatment plan.

I hope your blood test goes well and informs some further beneficial treatment that helps you feel much better - yes we must keep in touch, take care Sue x

[Beverley-NRAS]

Hi Sue730,

sorry to hear about your problems. I can't give you any information as far as PMR goes but I can tell you about RA. RA typically starts in the small joints of the body such as the hands, wrists, knees etc but that is not always the case. It is usually symmetrical in that it appears on both sides of the body but again some people feel the pain more on one side of the body, usually the dominant side that they use more. I have put a link below for you to the section of our website about diagnosing RA and it talks about the symptoms:

nras.org.uk/making-a-diagno...

If you or your GP suspect that you may have RA then the usual course is to be referred to a rheumatology consultant to get a definite diagnosis. If RA is then diagnosed the consultant will start treating the RA in most cases with what are called disease modifying anti-rheumatic drugs. I suggest that you go back to your GP and ask to be referred to a rheumatology consultant. As I mentioned, we are not experts when it comes to PMR and I do not know what the procedures are if it turns out that this is what you have. I have put a link to the PMR/GCA website for you:

pmrgca.co.uk/content/home-page

If you would like to talk about RA in more depth then please feel free to ring the helpline on:

0800 298 7650 Monday - Friday 9.30am - 4.30pm

Hope this helps Sue

Regards

Beverley (NRAS Helpline)

[Hidden in reply to Beverley-NRAS]

Thankyou that is really helpful feel like I have symptoms of both plan to ask for referral

[nomoreheels]

Hiya Sue730 & welcome to the NRAS site! I know little about PMR I'm afraid, just that it's treated with steroids, I think! I had clear indication that RD (I prefer to call it a Disease rather than Arthritis which tends to be misunderstood by many people) was my problem from blood tests which were taken by my GP. I was fortunate that she immediately recognised that it was most likely the cause of the stiffness & pain in my feet, the first place I was aware something wasn't right. This is pretty typical, the small joints being affected first so as you've noticed a difference in your hands & feet I would be pushing for your GP to take a blood test to check for Rheumatoid Factor & CCP. It sounds as though he's overlooking these newer symptoms & may be not thinking outside the box do you think?

Steroids are useful with RD, I'm on long term low dose deflazacort, but it is necessary if you do have RD to treat it with other meds called DMARDs & possibly NSAIDs & it's recommended the sooner the better if the blood test result confirms the possibility you may have it. I don't quite understand if he thought it was related why he's had you start tapering your pred but he seems closed to the possibility of something else being the cause.

I think I'd be pushing for the blood test & referral to Rheumatology if it's found it is a possibilty. The test won't necessarily confirm you have RD & further testing & imaging will need to be done but him treating RD is not in your GP's remit, it needs Specialist treatment. It could well be that the two problems are overlapping & your GP is not recognising the possibility of underlying problem, this is why I think the next step is to request a blood test.

I hope this helps. If you need any help or advice of diagnosis onwards don't hesitate to ask, we have a wealth of experience between us here. I wish you all the best in pushing for the test.

If you haven't happened upon our website whilst querying your symptoms it might prove interesting reading nras.uk.org.

[Hidden in reply to nomoreheels]

Thanks yes I am spurred on to visit go and ask for blood tests and referral ( wonder if I will back down if not forthcoming though !!!!)

[Angela123]

Hi Sue. Further to my previous reply, sorry in case I've confused you. When I saw NRAS I assumed you had RA diagnosed, and misread your post. As a member of both NRAS and PMRGCA communities (amongst others) I sometimes forget where I am! Hand and wrist pain you will see on the PMR site are common in PMR people, but your doctor should check you for RA as well. Ask to be referred to a Rheumatologist if you've not already seen one. They are the experts in both cases. Angela.

[Hidden in reply to Angela123]

Thanks again Angela there is definite inflammation as well as pain which has me wondering if it is r/a related so drumming up courage to push on for specialist referral ! Sue

[oldtimer]

I definitely think that you should be seeing rheumatologist. Quite a few people start with symptoms of PMA & go on to having RA.

[Hidden in reply to oldtimer]

Thanks looks like best way forward