PMR or Rheumatoid Arthritis

[PMRconnie2014]

I was just wondering if anyone else had been diagnoised with PMR and then been told it has possibly moved into Rheumatoid Arthritis. It's been four months since I was diagnoised with PMR by my Rheumatologist on November 24, 2014.

To recap: I had all the classic symptoms of PMR the end of September, 2014 with shoulder pain and stiffness, couldn't raise my arms over my head, took two hands to hold a cup of tea, severe pain and stiffness in the backs of my legs to the point I couldn't sit, could barely walk at times or get up from a sitting position, or out of bed, etc. and the only thing that helped was prednisone. I went through tons of labs, blood work, x-rays, worked with my internist, saw a neurologist, and finally the rheumatologist in November 2014 which resulted in the diagnosis. I was put on four infusions of prednisone in December, then started at 20 mg. daily of prednisone and 10 mg of methotrexate.

I'm currently at 12&1/2 mg. of prednisone daily and 20 mg. of methotrexate once a week and doing really well at the moment with the pain and stiffness gone for now and only dealing with the fatigue. At my check up with the Rheumatologist on Monday she told me that she thought due to the lab work, etc. in late February she felt that I was really leaning more to Rheumatoid Arthritis than PMR. I see her again in two months when they will do more blood work. I just wondered if this had happened to anyone else here. Any information about the differences in the two, deciding factors for diagnosis, etc. will be greatly appreciated. I know nothing about RA and was just starting to somewhat understand PMR. I was tested for RA in the early testing last October, but no positive results at that time.

Thanks for your help!!

[Carriacou1937]

Hi Connie, Your post mirrors exactly my situation. I was diagnosed with Pmr over two years. Started on 15mg. Went through several flares, but was coping OK. Until two months ago after ultrasound showed widespread inflammation, and now my condition is called inflammatory arthritis. Rheumatologist upped the dose to 30mg PRED and added Metrotrexate once a week, after no change added Sulfasalizine. Awful side effects. What I didn't expect was the setback with all this inflammation. I had injections in left leg and right shoulder which has helped. But my biggest concern now is pain in right hip, back,knee. This has made me more disabled than at the start of disorder. Walking is extremely difficult. I really did not know that this could happen with Pmr. And I wonder if this happens with autoimmune diseases.

Pmr Pro will help us I know.

This is my first post, although I have been following website for sometime.

Good luck Joan

[PMRpro Ambassador in reply to Carriacou1937]

Do try Bowen therapy for the hip, back and knee - it is very gentle and you would know quite quickly if it will help, 3 sessions at most to know although you might need more. It kept me upright and functioning when I wasn't on pred and quite a few people on the forum have tried it with great success. You walk badly with PMR and arthritis and eventually your back muscles go into spasm and that hurts so you walk even worse. Bowen will often sort it out.

[Carriacou1937 in reply to PMRpro]

Thank you very much. Will try to find one in my area. Joan

[Hidden]

Sound the same story as mine, but I'm still being treated as if it is PMR. My symptoms started last year about September time. Started on 15mg of pred, got down to 13mg then had a flair up and had to go back to 15mg again. Wow this thing is pretty tricky to control. My GP said it might be Arthritis but my specialist says it is typical PMR.

[PMRpro Ambassador]

About 1 in 5 patients who are given a diagnosis of PMR at first later have it changed to something else, usually (late onset) RA. It isn't they got it wrong as such, they can present very similarly. That is part of the reason for using only 15-20mg pred to start with. PMR responds well, other forms of arthritis don't respond so well or not at all. It is also possible to have RA without a positive rheumatoid factor test. Usually they start to consider RA if you don't react as well to pred as they thought or have difficulty reducing the dose though sometimes that is because they try to reduce too fast. Some people develop other blood indicators later.

[mamma1027]

I too was given an initial diagnosis of PMR. Started on 30mgs of pred nearly a year ago to which I had a good response, but have struggled with reducing it. The lowest I have managed is 10mgs for roughly a week. My rheumatologist (who is very good) is now leaning towards seronegative arthritis, possibly ankylosing spondylitis. I am currently taking 14mgs of pred, and 1500mgs sulfasalazine a day. I had got up to 2000mgs of sulfasalazine but the nausea was awful, so after speaking to my rheumy nurse she advised a drop down for a week or two. It's such a rollercoaster isn't it? I can't remember the last time I felt well. The constant pain just drags you down.

My bloods have always been negative for inflammatory markers. Interestingly, when I was diagnosed with fibromyalgia eight years ago I was positive for rheumatoid factor, but I am now negative.

I wish you all the very best and hope you get a definitive diagnosis xxx

[PMRconnie2014]

Thank you so much for all of the encouraging replies. Sad to say, but it's so nice to know that others are paddling upstream in the same boat, so to speak, and you aren't alone in this. This site has been such a blessing, and I read it frequently and have gained wonderful information. I post infrequently, feeling I know so little to help anyone else. There is very little in the way of this type of forum in the USA and few support groups for PMR. I guess if it does prove to be RA, there is more help for that in the USA. Again "THANKS!" so much for your input!!

[Suesie54]

Hi there, that’s exactly what has happened to me, diagnosed with PMR, 4 years ago now the specialist has said I have Rheumatoid Arthritis not PMR, very confused.

[PMRpro Ambassador in reply to Suesie54]

About 1 in 6 patients who are initially diagnosed with PMR go on to be given a differnt diagnosis at some later point. Whther it is a case of PMR morphing into an inflammatory arthritis isn't know but various disorders can present initially with just polymyalgic symptoms and since there is no definitive test for PMR or many inflammatory arthritides in their early stages it is easy to get the wrong diagnosis. Contrary to common belief, the response to pred is not diagnostic although PMR is characterised by responding very dramatically to a moderate dose of pred. Where doctors are tempted to use higher doses of pred the picture may be obscured as many inflammatory problems will respond well to steroids at higher doses.