Knee problems

[Loco99]

I have had PMR for about five years and it is reasonably well controlled with 5mg of Medrol. Recently I have been having problems with swollen and sore knees. I am slightly overweight, probably due to the cortisone and two relatively recent ankle operations which left me with very limited mobility for six weeks in each case.

I have been trying to do as much walking as possible but am being hampered by my sore knees. When I went to my rheumatologist a few months ago he examined my knees, noted they were swollen but didn’t mention osteoarthritis. He also didn’t say PMR was the culprit.

Is the knee pain likely to be PMR related or could it be something else? I can get rid of the pain by taking extra cortisone but I don’t want start upping my dose every time my knees get sore, I’m supposed to be tapering at the moment.

[SnazzyD]

Hello, If it is none of the above it could be the knock on effect of not walking properly due to the ankle problems. Limping or altered gait can really upset other joints which have to work in an uneven way. Any extra weight will compound it. Perhaps this has worn the cartilage or something. Might be worth asking to see someone who does knees orthopaedically.

[Loco99 in reply to SnazzyD]

You could very well be right, it took a long time to diagnose the ankle problems properly and they did affect my gait quite a bit for three or four years.

[PMRCanada]

An MRI of your knees will shed some light on your knee issues. I’m in the same boat and after MRI of both knees I found out I had OA in both, chronic knee injuries and all sorts of meniscal tears, along with a Bakers cyst behind right knee.

Ortho surgeon will treat right knee with Medrol injection next week. If it improves he will consider arthroscopy in the future.

He said PMR affects knees, Rheumy says no. I believe it does, and now can distinguish two different types of pain in my knees. As I lower my pred the organic knee issues cause more pain. I take extra strength Tylenol and rarely Tylenol 3 for my knee pain that is emerging from the deterioration from OA, etc, and I get some relief so I assume it’s not PMR.

I hope you get to the bottom of your sore knees. I wouldn’t increase pred just yet until you can better determine the cause. You could try Tylenol and see if you get relief.

Frustrating when we have concurrent medical issues and trying to figure out what is causing what. Is it PMR, pred, pred withdrawal, organic issues, menopause......the list goes on and on.

Keep us updated.

[Loco99 in reply to PMRCanada]

I took to iboprufen tablets a couple of hours ago and they made absolutely no difference to the pain or swelling. I am hoping the new doctor I go to will be able to do a proper examination and investigation. This year we have moved both house and country and I have yet to find a new GP and rheumatologist. Snazzy made a good point, I think the effect of PMR can affect our gait and that could be a factor too.

[Hidden in reply to PMRCanada]

My Rhuemy insists that PMR does not affect knees but I think he's wrong. Had an x-ray, joints are fine and he pronounced that I would never need knee replacements. Didn't come up with a reason why my knees hurt though. They were fine on higher dose of pred but as I've come down to 9.5 they have started aching at times, in fact I use them as an indicator for needing rest or able to reduce again. Hope this helps x

[Loco99 in reply to Hidden]

My rheumy couldn’t explain my knee pain either and also seemed to think my joints were ok. I think my PMR moves to whatever area of my body is weakest at the time. My ankles are sometimes painful too. I think you are right about the knee pain being a warning to slow down a bit.

[Hidden in reply to Loco99]

Yes my ankles and wrists are always to the fore when things hurt!

[PMRCanada in reply to Hidden]

My GP took X-ray if my knees back in Feb as a first step to investigate knee pain, nothing showed up. He later did MRI of both knees and uncovered loads of problems (complete torn ACL, every type of meniscal tear between both, OA in both with complete degeneration of cartilage in right knee leaving a spot bone on bone). Ortho surgeon will start with Medrol injection in right knee next week and follow up in Jan. If result is positive he will consider arthroscopic surgery to clean/flush out debris, trim meniscus behind knee and hopefully remove large bakers cyst behind right knee.

These chronic, organic knee problems cause a different kind of pain than the type of heavy, aching legs and tightness that PMR caused the first 5 months without diagnosis.

ChrisMcT, we are on the same timeline (I too was diagnosed with PMR this past May), and we both seem to be experiencing knee pain. I taper to 10mg next week (I had a flare in June due to the fast “textbook” taper given to me by my Rheumy).

So frustrating and confusing to be told different things by different doctors. Surgeon says yes PMR affects knees, Rheumy says no. ??

Hope you and Loco99 get to the bottom of your knee issues.

[Hidden in reply to PMRCanada]

Thanks PMRCanada, after reading your problems will definitely not be asking for further investigations! One illness at a time I say. I'm in the NorthWest of England and it has been wet and quite cold since August, forget those basking in sunshine in the South! I'm wondering if the weather is having an adverse affect on my grumbling bones, I have upped my preds to 10 today so shall see if I feel any better. I also have gained weight due to comfort drinking, usually sleep well though!!

[jinasc]

This article can help you to control the weight gain.

pmr-gca-northeast.org.uk/as... Page 4.

People with Type 1 (pre PMR) and Type 2 both pre and post, lost weight steadily and the best bit, was using a smaller plate. The eyes are deceived it looks full and you feel full but actually have eaten a whole lot less.

[Lochy]

I too have struggled with knee pain over past 6 months. 2.5 year into my PMR journey.

Left knee is main culprit and I’ve assumed as I taper all sorts of things break through. I didn’t want to increase oral dose of steroid as was feeling good in rest of my body! Knee X-ray showed slight swelling but not much more. I live in UK and am not offered more detailed examination under NHS.

Decided to see rheumatologist privately as couldn’t access treatment in NHS sooner than 3 months and knee was increasingly debilitating. Got about 17ml of fluid drained and a steroid injection. Made huge difference. Fluid analysed and very high blood cell count. Not prescriptive in itself says rheumy and could be difficulties with PMR or OA.

It’s now a month since injection and I feel the knee tight again in the morning but eases off quite quickly. Seeing rheumy again early November so will just see how it goes. What I don’t know is if it deteriorates again, what happens then.

Continuing with my slow taper from 9 to 8 at the moment and still feeling ok. It’s just the knee! There’s always something with me!

[PMRpro Ambassador]

My knees were a problem in the 5 years pre-pred - and the first rheumy I saw pontificated it was OA, she "could feel it". The knee pain disappeared with pred - so it was inflammation of some sort - and a recent x-ray because of a return of similar knee pain showed nothing at all although the pain disappeared a few days later. So can pred and an x-ray cure OA in 13 years????????

PMR may or may not affect knees (I think it does) but it DEFINITELY makes you walk funny - and that never does knees or hips any good.

[Hidden in reply to PMRpro]

I try very hard to walk properly but I cant. It's my ankles there are so stiff, looking round at other people in the supermarket today most of them seemed to walk funny even the young ones, perhaps it's the fashion! When I was a teenager we all walked with our arms sticking out with hands flopping loosely on our wrists, sort of 'Are you being served fashion' and our winkle pickers shoes would have to be thrown out sideways as we walked. Come to think of it no wonder I have complaining knees and ankles!

[Loco99]

Thank you for all the responses. My knees have been a bit better since changing shoes and ditching some inserts made for me by a podiatrist. Some people seem to swear by them others think they make things worse. It may just be a case of finding the right pair of shoes and not over doing things. Fingers crossed. It is all rather confusing. I think that the PMR may have contributed to my ankle problems due to the change in my gait, damage to one joint affects the others, so sorting out one problem might cause another.