PMR and Arthritis?

[mariacwelland]

Dear All,

This is such a great forum - I've learnt so much about PMR.

Question: On 15mgs of Pred I have no PMR symptoms, however I have lower back pain.

Is the lower back pain PMR or could I possibly have arthritis as well?

Any help/advice would be appreciated.

Regards

Maria

[DorsetLady PMRGCAuk volunteer]

Hi Maria,

Could be either, or other things as well!

If it's both sides, could indicate PMR. Is it there all the time, or only when you stand/walk? I have arthritis pain in left lower back, but it's fine when sitting or lying down, is only a problem when I put weight on it. Also have it in left knee and shoulder.

My GP reckons most people over 40 have arthritis in back, but not everybody gets pain!

Sorry to be so vague, but as they say "backs are funny things". Best get it checked! Then you can decide on a form of treatment, otherwise you could be wasting time and money on unnecessary medicines etc.

[PMRpro Ambassador]

Far more likely to be just that: "low back pain".

There are a few things that are often found alongside PMR which produce similar pains that can be mixed in with the PMR. The moment of truth comes when you take 15 or 20mg of pred and all the PMR stuff fades away but there are odd bits left over.

Trochanteric bursitis affects hips and can cause pain into the groin.

Piriformis syndrome can cause pain in the bottom of your buttocks and into the back of the thigh.

Both can irritate nerves and lead to referred pain and both can be treated.

Myofascial pain syndrome (MPS) is caused by the same inflammatory substances that cause PMR but they are localised in muscles rather than flowing through your entire body. They often form trigger spots on either side of the spine in your shoulders, about rib level and in the lower back - about where the baby's dimples are and can often be felt as hard areas of spasmed muscle fibres in the muscle. These trigger spots can spread over larger areas of the muscle affected and also irritate nerves leading to referred pain according to which pair it is, which can be over your back, and into arms and legs and ribs.

Your back is a very complex arrangement of different muscle groups which work hard all the time at keeping you upright and mobile. Most of the time it does very well but anything affecting some muscles inevitably affects the others, they pull against one another and the skeleton - and at some point a straw breaks the camels back and they say, hey, enough already stop abusing me. And they tighten up to stop you doing more to them and hurt to let you know! PMR is a superb scenario for that! You walk "funny" because of the pain and stiffness and it puts strain on your back - so it hurts because the muscles are tense and hard. The answer is to get them to relax again. Sometimes the oral pred helps to some extent and the pain eventually fades - but it sometimes comes back at lower doses.

Many of us on the forums have benefited from something called Bowen therapy for this sort of pain - it does nothing for the PMR but it often helps for the add-ons and I find it as relaxing and uplifting as a good massage anyway and others have said the same.

A good physiotherapist should be able to identify the MPS trigger points - and they can be worked on with manual techniques or steroid or muscle relaxant injections can be used to get them to "dissolve". Ordinary physio to work on strengthening the muscles isn't advisable at this stage - physio and PMR don't always mix well as the muscles are intolerant of exercise and the repetitive actions of most physio exercises are not good in PMR.

I'm sure someone else will think of things that helped them too. One very simple aid is a warm hot water bottle that you position over the sore area while you are sitting upright in a comfortable chair - not slouching on the sofa though!

[Celtic PMRGCAuk volunteer]

Maria, if you've never had back pain in the past, it is probably more likely to be linked to the PMR. I was plagued with lower back pain throughout most of my PMR 'journey'. I had experienced back pain previously due to having a slippage of my spine and this initially made it difficult for me to tell the difference between what was PMR pain and what was from my spinal injury. But I did gradually get to know the difference. With the PMR pain, came the difficulty getting up out of a chair and feeling pain right across the lower part of my back which would see me taking the first few steps doubled up like an even older lady than I am!! This lower back pain would sometimes take hold and see me having to sit down in the middle of preparing something as simple as my breakfast. It would also strike when out having a little walk and the only way to get relief was to sit on a handy low garden wall. At its worst, I found it helped to don a support girdle for a few days. If you haven't yet had a DEXA bone density scan, do ask for one just to rule out any sign of thinning bones as the cause of the pain.

[30048]

i do not have a good answer but I did have a MRI on my back and found that I did have severe spinal stenosis. The prednisone for the PMR was helping with that pain It is hard to tell if it is a combination of the two that is so bad in the AM. I have reduced to 12 mg of prednisone . I also have GCA so it gets complicated. Good luck....i guess i would just recommend a MRI.