PMR or osteoarthritis?

[Kshelsmi]

Can PMR damage joints? My knees had been stiff and swollen (especially the left) for the past year, and my doctor removed some fluid to have labs done last week; also took x-rays of both knees. There was inflammation, of course, but also crystals indicating something called Pseudogout. My x-rays showed joint space narrowing, severe on the left side. Before the PMR I had never had knee issues, so I was wondering if it’s all related somehow. Or maybe it’s just old age issues that would have happened anyway. What I thought was all PMR-related discomfort I now know is probably more Pseudogout and osteoarthritis! I guess I can really start reducing my prednisone now.

[HeronNS]

As far as I know PMR does not damage joints. I have osteoarthritis, have had it for decades, and it's unrelated to PMR which is a vascular disease.

[Christophene47 in reply to HeronNS]

I agree; my joints feel pretty good except for the vertebrae. My problem was muscle pain mostly and visual problems. I am C- ANCA positive, but rheumatologist thinks symptoms are in line with PMR/GCA. I think Prednisone is a God-send. I have never felt my age had anything to do with my symptoms; I am 71 now. I knew it was an illness and not age.

My maternal grandmother had PMR/GCA at my age. She felt so horrible, she went to the local ER on a bus that passed by her apartment by herself even though both my parents had jobs in supervisory positions and easily could have left work to take her.

Luckily, an astute ER doctor ordered the right blood tests and had suspected the diagnosis quickly. He told her it was a good thing she had come in because of the risk of going blind from the GCA. She responded very well to Prednisone; the next week, she was on a ladder scrubbing the walls. I remember that She needed new clothes because of weight gain. She recovered after a couple of years, and lived independently until 90. At that point, we arranged part time in home care with a nurse's aide who kept her and her apartment neat and clean and well fed. My father, retired by then, checked in on her frequently.The rest of her life she needed long term hospice care, but not for long; she died peacefully at 92. A PMR/GCA story with a good ending. She had a good quality of life for another 20 years after PMR/GCA.

[piglette]

I had hip problems and the orthopaedic surgeon said it was the steroids that had caused the osteoarthritis to get really bad.

[Christophene47 in reply to piglette]

Hip pain can come from back problems and of course arthritis. I am not sure steroids would make your osteoarthritis really bad; they do weaken the bones causing osteoporosis; have the steroids helped your pain? It could depend on your dosage and length of time you have been on steroids.

Does the doctor offer you any plan for your hips? You may want to ask for a DEXA scan to measure how strong your bones are, if not already done. If he is a surgeon, as you said, he may be thinking about hip replacements; if so, do get a 2nd opinion.

[HeronNS in reply to Christophene47]

It's true that pred can cause damage to joints. There is a very rare side effect, I think it happens quite soon after starting pred, called avascular necrosis which usually leads to a hip replacement. I think it can happen, even more rarely, to other joints as well.

[Christophene47 in reply to HeronNS]

You are right; avascular necrosis is a very rare side effect . As always, risks vs benefits must be weighed. There are also risks associated with hip replacement surgery; with any surgery.

[piglette in reply to Christophene47]

I had a hip replacement.

[Christophene47 in reply to piglette]

Did it go well?

[piglette in reply to Christophene47]

I was so worried the op would be postponed as in the end I was in an enormous amount of pain. I had an excellent surgeon and he kept my legs the same length thank goodness. I was ready to go home forty eight hours after surgery except I had a PMR flare and my CRP rocketed to 415. My surgeon would not let me home until it had dropped a bit.

[PMRpro Ambassador in reply to piglette]

But the CRP would also have risen due to the tissue damage

tandfonline.com/doi/pdf/10....

and tandfonline.com/doi/pdf/10....

found it isn't predictive of sepsis.

[piglette in reply to PMRpro]

It was obviously something to do with the op as well. Most people’s CRP rises after a hip op even though they do not have PMR. They just don’t have quite such an astronomical effect!

[annie_marie in reply to piglette]

Long time since i posted, but this thread is of great interest to me. Ive had pmr/possible gca for nearly six years. Treated with varying amounts of pred resulting in steroid myopathy.

My orthopaedic surgeon has also said I have severe osteoarthritis, ( xrays show bone on bone ) caused by the steroids.

I've just had total left knee replacement, then i need my right knee replaced, my shoulder, and....even my jaw, but I'm definitely not going there!

Would I have been in this mess without the steroids, who knows? But what I do know is I was very grateful for the relief they gave me from the pain of pmr, but the pain I am in now, still having pmr and osteoarthritis together is quite debilitating.

Hindsight is a wonderful thing, or is it? I wonder, would I have done things differently, probably not.

[piglette in reply to annie_marie]

I was eventually bone on bone. Thinking back I am amazed with the pain that I put up with. I don’t know how I stood it!

[PMRpro Ambassador]

PMR shouldn't do damage to joints - there is inflammation of the synovium, the lining, but it doesn't destroy it. Otherwise it is a vasculitis, blood vessels. And there may be tendonitis.

To coin a phrase "it's your age" - bits do start to wear out! Psuedogout is associated with degenerative arthritis and a range of autoimmune disorders but PMR isn't listed as one of them.

[Kshelsmi]

Thanks for the responses. I had this idea that once the PMR ran its course, I’d be completely back to normal. I guess there’s a little denial there about my aging body...my new reality. 🙁

[Constance13 in reply to Kshelsmi]

I have Psuedogout. It’s agony when the crystals get stuck, isn’t it?

I also have PMR and Polyarthritis, but the pain isn’t nearly as bad with those as it is when there is a crystal attack.😡

I feel for you! I am lucky the attacks don’t happen often, but when they do...........!

💐💐

[Kshelsmi in reply to Constance13]

Glad to hear your Pseudogout attacks don’t happen often. The thing with Pseudogout as opposed to gout is there is really no way to prevent it (by medications or eating habits), at least to my knowledge, because the crystals are formed from calcium. I’m learning so much about conditions I never knew were out there!

[Christophene47]

Hi Kshelsmi,

I was young (in my 30's) when my feet started to feel like being crushed in the middle of night. I toughed it out, but could not maneuver my feet into shoe the next morning despite no redness or swelling. I went to work in slippers.

I saw a podiatrist who thought it was tendonitis, and gave me a painkiller, but after no relief he ordered a uric acid blood test. He called me at home and told me my uric acid levels were very high, and referred me back to my family doctor who repeated the uric acid test twice because he could not believe how high the levels were. He prescribed a drug called Colbenemid which solved the problem; after a few years, I stopped the medication and it never came back. There was one occasion when it flared in my big toe while on the medication. The diagnosis was gout. At that one time, my doctor injected cortisone directly into the toe joint.

It just eventually went away and never came back .

If not already done, you may want to ask to have your blood level uric acid checked; gout is usually associated with the feet and big toe, but can affect any joint , even the hands. Why not the knees? My brother who is 60 recently had a gout attack. His doctor said he could take medication or follow a low purine diet. He worked with the diet for awhile, and it went away. So far, no reoccurance.

I would not start reducing prednisone until you speak to your doctor; it could trigger a worse flare up. I doubt it is PMR related. If it is gout, there is a specific medication for crystal related arthritis.

I do hope you have had all autoimmune blood testing done; osteoarthritis is plain wear and tear.

Good luck and keep us in the loop.

[PMRpro Ambassador in reply to Christophene47]

Just to note that there is a difference in cause (though not in symptoms) between gout and psuedogout. The crystals are made of different substances and the only way to know which is which is to aspirate fluid and look at it under a microscope.

[Kshelsmi in reply to Christophene47]

Thanks Christophene47. There is a difference between gout and Pseudogout, as PMRpro said. Pseudogout crystals are made up of calcium, so changing your diet or taking gout medications won’t help, unfortunately.

I’m glad you seem to have your gout under control. It sounds very painful!

[yogabonnie]

I hope you are getting lots of information and sorry you have these pains!!! I have had a hip replacement and have had bad osteoarthritis but after all the complaints I've voiced about prednisone the ONE thing it has helped is my arthritis, which also is inflammation, so it would figure. I don't hobble to the bathroom in the morning and I have no achy knees and hips and fingers... My doc assured me it would come back AFTER the prednisone is gone... (as will my hair) my main concern with the prednisone are my bones....but I'm working on it. I don't believe it damages the joints. I think age and genetics damaged the joints.

[SheffieldJane]

It’s the first time I’ve heard of psuedogout. My knees are troublesome too with pain and swelling. I have become more sedentary with PMR and this doesn’t help the joints nor does the extra weight from steroid use. I think we have to accept some wear and tear diagnosis if we are in the typical age group for PMR. I agree though, you can get on with your tapering programme.

[Whittlesey]

Hi Ksheism, I have biopsy proven GCA and PMR. After very painful times, I have had both hips replaced.

I also have acute flares of meralgia parenthetical, which cause a lot of thigh pain.

Would suggest MRIs of painful joints.

During a GCA and/or PMR flare any joint pain/loss of cartilage may be accentuated/aggravated.

After the MRI's -- treatment may be available.

Hope you feel better.

Best, Whittlesey

[PMRpro Ambassador]

However - despite the fact that PMR itself isn't thought to damage joints, I thought this was rather interesting:

ncbi.nlm.nih.gov/pmc/articl...

"Pseudo-polymyalgia rheumatica

PMR is classically a disease of older people, presenting with a range of symptoms including fatigue, early morning stiffness and subjective proximal muscle weakness. It is often a considerable challenge for the clinician to distinguish older patients with pure PMR from others presenting with polymyalgia symptoms resembling this condition. Recent work in a large number of patients indicates that CPPD arthropathy should also be included in the wide spectrum of diseases mimicking classical PMR [Pego-Reigosa et al. 2005]. Knee OA, tendinous calcifications and episodic ankle arthritis are proposed as the variables that predict those older patients with PMR features who really have an atypical pattern of CPPD arthropathy [Pego-Reigosa et al. 2005]."

[Kshelsmi in reply to PMRpro]

Thanks for sharing this - it’s very interesting.