Hi I have been taking Prednisolone for PMR for 18 months and now on 5mg each morning under the care of a Rhuematologist .
I have had Osteoarthritis for a good few years mainly in my finger joints . My Dr is now questioning if I have RA because my middle finger on the right hand is markedly more swollen and ultra sound shows Tenosynovitis .
All my inflammatory markers are normal as are my Rheumatoid factor , I am going for some sort of assessment this week at the Rheumatology Department .
So on one hand I am grateful he is very through but on the other hand it has freaked me slightly . He is already suggesting starting me on Sulphasalazine and I don’t quite know what to think so need to be well informed so would be very grateful for anyones own thoughts from their experience.
Thank you
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We really can’t comment except to say you are fortunate to have an early appointment In rheumatology……the tests that team will perform will ascertain what is causing your symptoms & will be able to start any medication you may need.
personally I would not take a drug until I had a confirmed diagnosis that showed it was necessary and might to some good!
Which joint is affected on this finger? RA tends to attack the PIP joint ( the nearer one) not the DIP joint (finger tip one) , and is quite commonly symmetrical so attacks both hands. Often it is the knuckles that are affected first anyway.
Hopefully this assessment will include a blood test called anti-CCP which is more specific to RA. If it is positive then pretty sure sign that this is the diagnosis. But being negative doesn’t rule RA out tho’!
There are so many causes of tenosynovitis (including inflammation sparked by OA) that you should try not to freak out. Chances are that it’s not RA.
I agree with helixhelix, normally RA is symmetrical because it’s a systemic illness. It is not uncommon to get tenosynovitis in joints that are affected with OA. With your bloods all being normal, I wouldn’t panic at the moment. Drs just like to eliminate all other causes for symptoms seen, rather than assuming it’s the obvious cause. I also had polymyalgia and GCA for 5yrs, before a different rheumatologist 250 mile away diagnosed ankylosing spondylitis in addition to the PMR. Unlike you I was left to struggle under local rheumatologists who refused to accept I had GCA symptoms, because I was 47 and not 50. So you’ve been fortunate to have a team with their eye on the ball 🤗
My first symptom was a locking middle finger on my right hand then a slightly swollen knuckle and my left has never been affected ever. The truth is we can’t know as RA is symptomatic so affects everyone differently but these days there are loads of medications and it is treatable. Sadly not everyone gets the right medication first time so patience is vital. Don’t worry to much as you don’t know if it is RA yet and if it is then it does sound like your GP is on the way and that really is great.
In contrast, I have psoriatic arthritis which is meant to be asymmetrical - they say it's one of the ways to distinguish it from RA - but my inflammation almost always presents perfectly symmetrically!
Until I got psoriatic arthritis I thought that these diseases were easier to diagnose. I was first diagnosed with PMR, then this was changed to fibromyalgia, then seronegativeRA and fibromyalgia and lastly fibromyalgia and psoriatic arthritis. This took 4 years. So, it is really good that your doctor is sending you off for another assessment. I hope the rheumatologist is really good and checks your other joints for swelling. Hopefully, it will turn out that you have the PMR and you will someday get better.
I too had pmr in 2001,many years ago and was on preds high dosage.Unfortunately,in those days the meds today were not available,so for me damage to joints was considerable before todays drugs became available.Now on JAK which is excellent but cannot reverse damage to joints.What I am saying really is far better to be diagnosed now than 20 years ago,as meds are so much better,and it appears that there seems to be one that suits most,when you find it.Ihave been on prednisolone for 23 years and this has cause diabetes,so todays choices are much better.Good luck and keep us posted.
Your right PMR doesn’t damage joints but my Rheumatologist always checks my hands which have Osteo in most of the joints (seen on X Ray ) but now my middle finger right hand has changed . I am just struggling with the idea that such a small change can indicate RA.
I should be grateful I am well looked after and for modern meds .
I hope your appointment goes well and you get answers about your finger. These diseases are so complicated. I feel grateful but, honestly, I wish I never got this disease in the first place. You have been tolerating the prednisone so if you end up on something else for inflammatory arthritis you might find it gentler than the prednisone. I just remember knowing someone on prednisone that was pretty sick from side effects so that is why I say this.
It isn't uncommon for long standing PMR to morph into a diagnosis of Rheumatoid Disease. Going onto treatment that would enable you to reduce and possibly come off prednisolone would be the aim, while reducing the inflammatory process that damages your joints. Salazapyrine or hydroxychloroquine - or possibly methotrexate - might be protective.
Have a look at the treatment pages on the NRAS website so that you are familiar with the advantages and disadvantages of the various DMARDs (Disease Modifying Anti-arthritic Drugs).
Write down five questions that are worrying you. It will keep you on track during your consultation and give you grounding. Take someone else with you to listen as well. Consultation can be full of jargon that one person can miss. Good luck🌈
As others have said, we all present differently so I think it's difficult in the absence of a serological marker such as RF or anti-CCP to be sure. I presented with the hallmark signs of PMR (mother and sister were diagnosed and what happened to me was identical) and hands/feet weren't affected apart from a little soreness which I wouldn't have gone to the doctors for on it's own. I was so shocked when anti-CCP positive test came back. I have been treated for RA for over a year now and until I had to come off my meds, I still had a mistrust of the diagnosis because I just didn't have the expected symptoms. However, coming off MTX because of side effects has led to the return of symptoms with a vengeance.
After two years on Prednisolone for PMR, now I have PMR induced RA (seronegative - so no show in the RA marker). I've also been on Methotrexate too but started Leflunomide to help the RA as the Prednisolone was the only thing managing the inflammation. Very upset stomach and bloating so hoping to change to something better. Goo luck with yours.
I was trying to wean off the Prednisolone and had gotten down to 3 mg but my CRP level had risen to 90 and I had swelling in my wrists and feet and most joints were stiff and painful. The rheumatologist diagnosed poly arthritis and RA at that point. I also got tested for Giant cell arteritis with PET scan and ultrasound due having been on prednisolone for 2 years but luckily it was ok. Not sure why it changed to RA, but I guess it was the joint issues.
Poor you I seem to be stuck at 5.5mg but perhaps that’s where I should be with the PMR , it’s been 18 months . Rheumatologist thinks it’s been masking something else that is now becoming more evident . Even though I have been on 6 to 5mg for 10 months !!!
Most of the joints in my fingers have Osteoarthritis but Ultra sound on my right middle finger shows Synovitis in the tendon he thinks it’s early stage of Inflammatory arthritis and wants me to start Sulphasalazine .
I have been extremely fortunate that I have seen him 4 times in a 16 months and he is always thinking what else could this be ? He is of the school that inflammatory markers should be raised for PMR and mine never have been . So I am either very lucky if it is IA and he is jumping on it very early or going to be treated for something I haven’t got . Just struggling to get my head around it all .
I guess at least Sulphasalazine can be stopped without the dreaded Prednisolone tapering .
Sorry for the long post and thank you all for the info and support .
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well farewell everyone I don't have RA
What I have got, not what I haven’t got!
Do I have RA
Why have I still got pain?
