PMR or Psioriatic Arthritis (PsA)

[Paulbiker]

Hello I a newbie here, so forgive me if this is bit long and rambling.

Finally got to see rheumi (privately) in October who thought I had one of the two above!! my issues all kicked off in Feb, overnight. He gave me a 1 month course of pred which definitely helped but was not the magic bullet associated with PMR. so after 6 week review he decided PsA, and referred me back to NHS, his clinic, for treatment.

Recently saw different rheumi ( one of previous rheumi's colleagues) at same clinic, on NHS, who decided initially it is PMR, and has restarted pred, so now I think I'm playing snakes and ladders and have just gone down a snake to beginning of the game!. She says lets review again in 8 weeks and maybe it will be PsA and different medication - dmards - methotrexate.

I am now being offered alendronic acid and am concerned. So have booked to talk to my dentist about AA. my thoughts are to decline the AA certainly till the 8 week review, and ask for bone density scan, (even if I have to pay for it?), for now, and take Vitamin D instead, which rheumi has suggested as well as AA. Once I get to 8 week review I will know if I am staying on pred or moving onto methtrxate?, and if poss will have a baseline for bone density??, if I come off pred I shouldn't need AA, but maybe will need to stay on pred until the methetrxte kicks in, (4- 8 weeks apparently)

I have a new recent development of a pain in the ribs on the left side of my back, does anybody know if this rib pain is associated with either PMR of PsA? or am I now turning into a hypochondriac !?

comments please.

[PMRpro Ambassador]

Hi and welcome.

Do you have a history of psoriasis? If not, what were the grounds for suspicion of PsA? It is a common desire to make ?PMR into PsA - I don't know why.

I would refuse AA until 1) you have a dexascan result and 2) they decide what they are going to treat you as having. You will almost certainly need calcium and vit D if you are on AA so start with that for now - and get your calcium and vit D levels checked first. If it is an inflammatory arthritis it may take mtx well more than 6-8 weeks to "kick in" - up to 6 months is the usual line of talk. It is unlikely to work for PMR on its own.

Rib pain - either costochondritis or possibly myofascial pain syndrome which leads to the formation of pairs of trigger points in the back muscles: in the shoulders, about rib level and in the lower back. These can be felt as hard knots of muscle fibres and put stress on the muscle and the fascia itself (the transparent skin you are probably familiar with from joints of meat) but also irritate nearby nerves and cause referred pain in the area the nerve supplies: shoulders into arm and neck, low back into the legs as sciatica and at rib level round into the ribs.

[Paulbiker in reply to PMRpro]

Thanks for this. 're your psiorisis question I have a patch of a skin irritation on back of head for years. It has never been formally diagnosed but certainly looks like psiorisis, as I can't see it I have just lived with it, just scratching a bit!

[SheffieldJane]

You are making some good informed choices when you get the chance. It is wise to have a DEXA Scan before taking AA or similar - these are serious drugs and you may not need them.

The usual treatment protocol for PMR is to start on anything from 25 - 15 mgs, depending on your symptom control and once your PMR symptoms are settled start a slow taper of not more than 10% of your dose.

A Calcium prescription is usual along with the Vit D. A lot of us are prescribed ADCAL. You can support your bones with light weight bearing exercise and a good low carb diet.

The duration of Pred can be anything from around 2 years to much longer. The aim of the taper is to reach a comfortable dose that suits you, the lower the better. Reducing in tiny increments ensures that you don’t miss that dose.

Methotrexate can help you to get off Pred a bit more quickly and is proven to help with Arthritic joint Pain you will experience from Psoriatic Arthritis. It does come with significant side effects that not everyone can tolerate.

You are not a hypochondriac , these diseases make us feel like we have abnormal health anxiety because they bring multiple odd symptoms with them. I certainly had the rib pain you describe ( I named it the PMR hug). An XRay showed nothing significant . You can get Costochondritis that is inflammation of the cartilage where the upper ribs attach to the breast bone. Rest and painkillers help - not anti inflammatories because of the harm to your stomach of steroids and this type of painkiller combined.

Psoriatic Arthritis has been mentioned to me as I have Psoriasis on my feet only. I keep it under control with night and day moisturising with a base cream. It is hard to tell if it adds anything to the Osteoarthritis that has been diagnosed by X Ray.

A warm welcome to you. There is a lot of good support and experience to be shared on here.

[Paulbiker in reply to SheffieldJane]

Thank you, yes I too have x ray confirmed osteo arth but they seem to have mixed up which knee is worse as only one has been x rayed recently and the stiffness is in the other ? So back to the or psa

[Paulbiker in reply to Paulbiker]

Oops should be back to pmr or PsA?

[PMRpro Ambassador in reply to Paulbiker]

Sometimes the symptoms and the radiographic evidence don't match!! It can look awful on the x-ray but the patient says it is fine - or they can't move and the x-ray shows good cartilage!

[Blearyeyed]

Well done , you may be new but you are taking sensible actions and looking around for advice.

Everybody is in agreement with great advice above.

You could have PMR but you could also have Psoriasis as well which has been so mild in previous years that you felt like you needed to get it diagnosed.

This can explain in part why Pred was getting a good response but not a full ' magic bullet' in the more common time frame. Many of us have more than one condition and find the treatments we get for each of them take longer to work or we don't get 100% Pain free.

We often need more than Pred alone to manage all of our conditions as well.

This could also be the cause for the confusion between Rheumatologists , they are clever , but for some reason can take some time before considering that a Patient has come in with two separate conditions that both need diagnosing at once ( one triggering worse symptoms in the other) It isnt always and ' either / or" situation.

It may be worth helping the Consultants out just asking the question very politely and simply next time you go , " We are looking at PMR or PsA , but could it be both?"

Have a Dexascan before choosing AA. Take your vitamin D and Calcium , and keep an eye on your left side pain , it could be an adjustment , some inflammation but it could also be that you are suffering from some stomach sensitivity and acid from being on the steroids. Try taking your Pred with a bowl of probiotic honey and a little honey to coat the stomach . And gentle stretching and Paracetamol might help the pain if it's muscular. If it continues ask the GP and also come back here with any questions we are happy to help.

And never call yourself a hypochondriac , you are a sensible human being with a new Health Condition and getting to grips with all the side effects and aches and pains is the best way to help recover.