Is a Bursitis/Synovitis a symptom of PMR/GCA? - PMRGCAuk

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Is a Bursitis/Synovitis a symptom of PMR/GCA?

Funky-Butt
Funky-Butt

My OH with PMR and possibly GCA has a large sausage shaped bursitis/synovitis (I'm not actually sure what the difference is) in his groin/thigh. Found with ultrasound scan. Thought it was a completely separate thing to PMR/GCA, although it appeared (started hurting) about a week before the PMR symptoms in shoulders arms & hips. Is it related? There's a comment in the "Living with PMR-GCA" handbook about it taking longer for bursitis/synovitis to fade..

My questions are: What exactly is it/are they, and how/why do they appear? Are they part of PMR, GCA or both? Is it dangerous? How long do they take to fade ?

19 Replies
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PMRpro
PMRproAmbassador

Trochanteric and iliopsoas bursitis can be closely associated with PMR - it is a recurrent problem for me. I don't think it is dangerous no- hope not, since I have it too!

orthoinfo.aaos.org/en/disea...

Synovitis and tendonitis are often found in various body parts in PMR. Trochanteric is particulalry associated.

clinexprheumatol.org/articl...

uptodate.com/contents/clini...

says

"The term polymyalgia rheumatica implies a myopathic process, but the muscle in PMR is histopathologically normal. It is in fact the proximal articular and periarticular structures (joints, bursae, and tendons) that are mainly affected in PMR, as has been demonstrated by scintigraphy, ultrasonography, magnetic resonance imaging (MRI), and positron emission tomography (PET) [15-18] (see 'Imaging' below). Findings at the shoulders include subdeltoid/subacromial bursitis, biceps tenosynovitis, and glenohumeral synovitis. Bilateral subdeltoid/subacromial bursitis is an imaging hallmark of PMR; a meta-analysis of four ultrasound (US) studies found this abnormality in 66 percent (95% CI 36-87 percent) of patients [19]. Trochanteric bursitis and synovitis at the hips can be seen, as well as iliopsoas bursitis [20,21]."

It took about 4 or 5 months before I realised my hips no longer hurt as much - but I had had it for the best part of 5 years so there was a lot of inflammation to be cleared out and I only ever took 15mg. Hip joints and bursae don't have a brilliant blood supply so they don't get high doses of pred to them. that's why a more local injection has so much better results.

Does that help? Say if it doesn't.

Hindags
Hindags in reply to PMRpro

After 22 months and reducing from 20 to 4mg I still get the occasional odd pain in right shoulder area and less so in the groin. Since those pains do not come with stiffness, just pain on movement, I didn’t know how they would be related to the PMR.

Definitely get some DOMS. The other day in a hurried moment, I pulled a towel out from the bottom of a heavy pile of stuff, I sort of knew I’d pay for it for a few days. Two day later that bicep is complaining a lot when I move my arm in certain ways.

Now I wonder if the things I am doing that bring on the DOMS are also putting me in danger of flaring. Some of those things include doing my normal morning exercises maybe just slightly more robustly.

Do you have any diagrams for the shoulder like the ones you linked for the hip?

Thank you!

PMRpro
PMRproAmbassador in reply to Hindags

Does this help?

physioworks.com.au/injuries...

just google it and then look through the links they offer.

I don't think that actions cause PMR flares - but I'm pretty sure they will irritate bursitis and MPS and it may FEEL as if the PMR is involved. Some doctors will try to tell you that physio or rest will improve both but I'm not convinced: if the PMR is active, even if it isn't a flare, then that is contributing to the inflammation and even with rest the inflammation is still being fed. Having a steroid injection will cool that inflammation much more quickly and it has a chance to clear out and heal.

Hindags
Hindags in reply to PMRpro

That is an amazing amount of information. Thank you once again. It will take a bit of study. My first reaction is wondering why neither my shoulder nor my groin has ever been imaged.

PMRpro
PMRproAmbassador in reply to Hindags

I think it would be wonderful if all query PMR patients WERE imaged - and even better given PET scans because I'm also pretty sure that far more of us with a PMR diagnosis actually have LVV or even GCA. But it is a question of resources and costs - the imaging costs more, PET scans even more and the equipment itsn't universally available. And all fundholders are aiming to keep their costs as low as they can.

piglette
piglette in reply to PMRpro

Someone told me that all the PET scanners in U.K. are actually privately owned and rented out to the NHS. I am not sure how true that is.

PMRpro
PMRproAmbassador in reply to piglette

ncri-pet.org.uk/pet_facilit...

You could do the research ;-) But I doubt all of those are private somehow...

piglette
piglette in reply to PMRpro

It did sound rather unbelievable, but I will believe anything with the NHS nowadays. Having spent all that time fundraising for our Dexascanner which we would not have had if it had not been for loads of coffee mornings etc.

Yellowbluebell
YellowbluebellAmbassador in reply to PMRpro

From this post I have just realised that the repeated shoulder ops I have had (7 on right, then a shoulder replacement, and one op on left) over the last 14 years are more than likely something to do with pmr?!! I am due to see my orthopaedic consultant later this month so will ask more questions than I normally do.

Baileyw06
Baileyw06 in reply to PMRpro

The shot of cortazone helped the bursitis in my right hip.It also helped me in tapering.

Funky-Butt
Funky-Butt in reply to PMRpro

Yes it really does help, thank you. We'd been waiting for what we thought was a torn muscle to heal! It appears to be a PMR only problem, not GCA, would you agree?

PMRpro
PMRproAmbassador in reply to Funky-Butt

As I said above, PMR/LVV/GCA all blur into one for too many doctors and your diagnosis depends on what predominates. GCA is perceived by some doctors to only be cranial (in the head region) but without extensive biopsies that simply aren't possible except port mortem they can't tell if it is GCA or "just" any old vasculitis. A lot of us with "just" PMR diagnoses very probably do have more extensive disease. The pictures here are good even if the text is a bit tough going in places:

academic.oup.com/rheumatolo...

PMRpro
PMRproAmbassador in reply to PMRpro

I've just realised how good the bit under "GCA beyond temporal arteritis—tracks from history to modern times" really is - should be required reading for all doctors looking after PMR/GCA patients,

I had a golf ball size bursitis behind my knee in the beginning stages of PMR. (I was 9 months without PMR diagnosis) It just gradually disappeared. I presumed that the Prednisolone fixed it but maybe not from what PMRPro said. Thinking it was a separate issue I did wonder if it would come back post PMR and steroids.

Interesting! I never mentioned it before because I never considered it was connected.

Sheilamac
Sheilamac in reply to Sheilamac

Bursa

Try The Bowen Technique. My Partner who is a Bowen Therapist is treating a Lady who has suffered Bursitis for ages. The Lady in question has had 2 treatments so far and the clicking in her hip has gone as well as the pain. Worth a try.

PMRpro
PMRproAmbassador in reply to Barrytres

FB - if you decide to try Bowen, speak to Mavis and get the contact for her Bowen therapist. She was in Carrville but moved to Meadowfield. Wonderful!!!!

Hi I'm back on this brilliant site again. I've been free of PMR symptoms for 18 months now after taking pred for only 1 year..however 2 months ago my stern vehicle joint started swelling and was giving serious neck pain. I didn't associate it with the PMR at first until the neck pain radiated much worse I thought I must have an arthritic joint. An exray showed no bone calcification so just had a scan this week and have chronic inflammation of the sterno clavicle joint lining...although the hospital doctor said it's in keeping with a PMR flare my GP has only given me 2 weeks of pred as he says PMR affects muscles. Here we go again with the struggle to get doctors to understand this disease better.

I have an appointment with a rheumy coming up but not until end of November. Has anyone else suffered with this joint? Id like to be well armed before I see the rhumatologist although he should know more than my GP.

My problem has been that my bloods haven't shown much raised.

PMRpro
PMRproAmbassador in reply to chris2ubelle

You would be better posting this as a new thread so more people will see it.

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