An encompassing paper on the arthritidis from the umbrella of EULAR - European League Against Rheumatism
(snip...) 'Common inflammatory joint disorders in adults include crystal-induced arthritis, rheumatoid arthritis (RA), and spondyloarthritis (SpA) including psoriatic arthritis (PsA), reactive arthritis, enteropathic arthritis, and ankylosing spondylitis (AS).[2] Additionally, inflammatory arthritis or bursitis in older patients (≥ 50 years of age) may be a result of polymyalgia rheumatica (PMR) or crystalline arthropathies.[7–9] Common symptoms of inflammatory arthritis may include joint swelling, erythema, morning stiffness longer than 0.5–1 h, and radiographic evidence of bone loss around joints.[10,11] The number of joints involved, the type of joints involved (e.g., small vs large), and the pattern of joint involvement (e.g., symmetrical vs asymmetrical) can also be similar between arthritides.[1,12–14] Further, unique disease manifestations, such as enthesitis and dactylitis in obese patients, can be clinically challenging to detect.[15] Additionally, serologies may fail to conclusively differentiate between these diseases and elevation of acute-phase reactants is nonspecific.[16–19]
During early disease and in patients with milder symptoms, in whom clinical findings are not definitive, imaging is needed to accurately differentiate between different types of inflammatory arthritis. European League Against Rheumatism (EULAR) recommendations for the management of early arthritis are guided by an overarching principle that "a definitive diagnosis in a patient with early arthritis should only be made after a careful history taking and clinical examination, which should also guide laboratory testing and additional procedures".[20] In our opinion, imaging, just like clinical examination, needs to be considered in the context of clinical presentation, with possible differential diagnoses taking demographic characteristics into account (Figure 1). In current practice, ultrasound, magnetic resonance imaging (MRI) techniques, and, to a lesser extent, computed tomography (CT) are generally regarded as superior to conventional radiographs for identifying and differentiating early signs of inflammatory arthritis.[21] While MRI and CT are useful, CT is limited by exposure to ionizing radiation and MRI is limited by high cost and limited availability. Ultrasound, a non ionizing imaging technique, is often preferred because many musculoskeletal structures can be examined, it can be performed at the point-of-care, and it can be used on patients for whom MRI is contraindicated. In patients with inflammatory arthritis, ultrasound can detect important clues such as subclinical synovitis, asymptomatic entheseal inflammation, bone erosions, and crystal deposits, which could otherwise be missed in physical examinations.[4,22–28] The importance of ultrasound has also been highlighted by its inclusion in the two most recent EULAR/American College of Rheumatology (ACR) classification criteria for PMR and gout.[29,30]
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Ruadh
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I had seen that. I put it here, prompted by a recent post by a member who was in a diagnostic situation re PMR /etc. : GP refusing to acknowledge he might have PMR. I responded, so did PMRpro, discussing the possibility that given the clinical details he outlined, maybe he had AS, Ankylosing Spondylitis.
The paper really covers the arthritides in general, and does mention on PMR. Cannot really categorise it into a single arthritic section, but in its entirety might be useful to members here. The paper covers screening in all its guises for arthritic conditions, suggesting that ultrasound is an inexpensive and quick way forward.
I think arthritic conditions are not taken seriously enough by GPs a sort of prevailing attitude of “ wear and tear” and your age. For me symptoms have definitely got worse during the PMR years.
I found this very interesting, I have been loosely diagnosed with PMR by my Dr, I have recently had an initial consultation with a Rheumatologist who has suggested that in his opinion, I have RA not PMR. I’ve had blood tests and urine samples, I’ve got an ultrasound on Friday next week followed by a follow up appointment with my Rheumatologist.
As I have been tapering the prednisolone dosage I’ve been getting mild aching and in my fingers, knuckles and toes (no swelling, heat or redness) .
I’m very eager to get a proper diagnosis so that I can get the correct medications etc......
There is so much advise and help on this forum, I’m finding it very helpful indeed 🙂
My rheumatologist says that PMR always overlays an inflammatory condition which in my case is arthritis. I have been on pred for 3 years but in the last 18 months I was getting increasingly stiff (something I have had for years together with strange aches in the wrists a bit like an electric current). When I finally saw a rheumi a few months ago, he sent me for a barrage of tests which showed that my joints are very good for my age (70). He prescribed a slow release anti-inflammatory for the stiffness and it has proved very successful; I am walking again and not like a half dead, manky penguin!!!
I don't think it really matters what we call it and I think that "arthritis" is a convenient umbrella term for lots of symptoms/conditions so long as we find something to improve our quality of life.
I'd like to know his evidence for that claim. PMR is a vasculitis, like GCA, it isn't the same thing. But I still think that autoimmune disease doesn't flow down delineated paths - it crosses over and the label you get depends on which symptoms predominate.
Is your slow release anti inflammatory available over the counter?....I am as stiff now as I was 8 years ago...my family have always thought I have been misdiagnosed....but I can see the dilemma of doctors with such overlapping symptoms....
If it is any consolation (or not) - I suspect some doctors struggle too! I suppose a basic problem remains that in most healthcare systems the GP/PCP/family doctor remains the gateway. When they are not experienced in musculoskeletal medicine then it is all too easy to fall back on "age" and "wear and tear" as answers. It is what I was told by my usual GP when I was only 51 and reasonably fit. Then a rheumatologist informed me I had OA, she could "feel it" - but 13 years later there was no sign of the putative OA in that knee with imaging. There could well be - it was mangled in an skiing accident - but there certainly wasn;t then.
I don't really understand why GPs are so unwilling to send patients for, at the very least, an x-ray. But it was ever thus. Now the waiting lists for specialists pose a problem - if everyone was referred they would be even worse.
I found this interesting from the point of view of my sister in law. Her diagnosis ranges from PMR, arthritis and fibromyalgia and she really doesn’t know if she is coming or going.
I have that triple (and more) dx... She may have all 3. I have treatment for all that tweaks things slightly differently in each case. I think luckily I had fibro years prior to pmr and was on treatment that helped. Then I got new pain that the treatment didn't. Of course pred at a certain level covers OA to some extent. I really hope your sis gets sorted!
Thanks Scoopitup. It’s really getting her down and she is having continual gastric problems so they’ve told her to drop from 10 mg to 7.5 mg and she’s had to stop methotrexate and intravenous methotrexate.( had problems before this with diverticulitis) I don’t think they really know what they’re doing and I can only hint at things as she doesn’t really want to discuss anything. What a mess!!
Oh dear. I had almost 12 months of severe gastric issues last year. Scan, colonoscopies etc. All clear re sinister things... Diverticular inflammation with post viral mixed Ibs was the dx. I was prescribed naxogel to combat the long term constipation of taking tramadol, but that made tramadol work less effectively. I stopped taking it and am deciding if I just manage with laxatives mixed with buscopan and immodium as required or see what the next trial of pills will be by gastro. I am loads better than I was before Xmas. I hope your sister gets to the root cause and a workable resolution. It's not a nice feeling.
Thanks Scoopitup. Interesting your diagnosis. Really pleased you’re feeling loads better. Xx
There is conflicting evidence re OA and Crp apparently but I think many of us seem to feel pre existing OA seems to be a bit better at 15mgish or higher but creeps back as pred goes into single figures. Of course we are getting older!
I have OA in the right wrist joint diagnosed at the same time that I started preds for PMR, I had an accident 30 years ago and smashed my wrist to pieces. Several operations later with plates and pins etc left me with an already damaged wrist that was bound to end up with OA, especially as I am a manual worker
I’m finding now that I am reducing preds that there are some aches in that wrist that are different from the left side most likely to be related to the OA
I think crp and esr can be tricksters and as you have no doubt read some people don't raise out of normal ranges, and others can be in 100s and feel reasonably okay, but Dr's panicked. Stress/surgery/colds can cause a blip as a post by dorsetlady discussed last year I think it can be found if you go into Dorsetlady's profile... It was a post so should be easyish to find.
Have you just had the one set of tests? Or has it been an upward trend since the sepsis? I would be asking for a series of crp or esr tests and keep a diary of any and all symptoms or stressors. I hope you find out what's going on (if anything). Let me know what happens.
I doubt it raises it very far but there is evidence that it can be raised - but how do you prove it is due to OA and not some other undiagnosed thing going on at the same time such as PMR. This study, for example, small though it is,
talks about synovial membrane inflammation and that is recognised as being found in PMR. This does appear to be not particularly current - as it accounts for knee pain in PMR.
You have certainly had a few things going on to account for the markers yoyoing! When you want Dr's to take an interest they ghost us.... When we are wanting to just go forwards with life they are in our pockets! The gastro is a bit like that with me at the moment and I need to decide if I want further appt.
I have to have blood testing for diabetes quarterly and my dmard blood test falls within those quarters. Then you get HOSP appts and this week I have the dental HOSP and then by the time I trail to the pharmacy twice a week I am exhausted!
Originally diagnosed with PMR and then OA in knee. After playing with grandkids in ocean inflammation above knee. Dr sampled inflamed fluid and diagnosed as inflammatory arthritis. At time was on 4mg of prednisone; was advised to go to 20mg for 2 days, 10mg for 7 days, 5mg for 7days and then 4mg for 1mth. and continue tapering
Good question!! Since I wasn't complaining about a flare, have to assume it was inflammatory arthritis. Nonetheless, as I was tapering I did have increased tendinitis discomfort (I have been independently diagnosed with tendinitis)l which has diminished but not eliminated with the recommended increased prednisone dosage.
Prednisone is actually good for inflammatory arthritis too, although quite often single steroid injections are given every few months. The relief these gave me was excellent and lasted about 6 months at a time.
Yes. A potent anti-inflammatory, unfortunately, is eventually damaging to tendons and ligaments - weakens them, keep away from joints. Also, it is advised no more than three - after which, finis !
thank you...so many of the same symptoms, I've often wondered what I really have...Dr. & me are thinking PMR but haven't had any further testing at a more advanced medical facility such as Mayo's or UofM...
Thank you so much for this. I am currently 'in the system' and waiting for a diagnosis. The consultant has query diagnosed axial spondyloarthropy /inflammatory arthritis though I feel I have PMR.... Am waiting for the results of an MRI, hopefully for clarification! Desperate for treatment for pain relief!!!! 😕😥 Your post was very informative as this is a whole new world to me - thank you.
The second rheumy I saw, over 3 years after the first who said osteoarthritis was causing the knee pain as she could "feel" it, was insistent it was a spondlyoarthropathy of some sort despite a magic response to 15mg pred in under 6 hours. He eventually gave up on ankylosing spondylitis when imaging said no but not on inflammatory arthritis of some sort. No other doctor has suggested it. And that osteoarthritis? Over 13 years later there was no sign of it in an x-ray last year. No knee pain either now.
Thanks, as always PMR Pro. I am feeling really down as an acquaintance with exactly the same symptoms as me but more recently, rang the same surgery as me, spoke to a locum who diagnosed PMR and put her straight on pred. I have been in the system for months now with no answers and no medication which works. I have had to stop the Etoricoxib as it gave little relief but caused huge gastric discomfort.
And said acquaintance is now skipping around like a new woman while I'm crying with pain. So annoying.....!! Just shows it all depends who you speak to.
Locums are sometimes a boon - but many patients are reluctant to see them! No chance of speaking to a GP to get something moving at least in the interim?
Have had MRI which, 4 weeks later, I heard showed signs of axial Spondyloarthritis (I appear to have THAT gene...)and my bloods show slightly raised markers for RA 🤨 for which I’m now booked in for ultrasound. The head honcho at rheumatology has agreed to see me so they can hopefully/ finally make a diagnosis, but his waiting list is loooong.......😩 Meanwhile I have all the symptoms of you lovely people, but no-one will acknowledge that I could have PMR, and I am left with NSAIDS which either give me huge gastric discomfort or mouth ulcers, and don’t get rid of the pain anyway..... If I end up being diagnosed as having a range of inflammatory arthritis conditions I will have to leave this lovely group, but don’t know where to go...... Can’t seem to work out what group I would come under as all the arthritis support groups focus on joints and I don’t have swollen joints - I have throbbing inflammation coursing through me!!!! Any advice??
We have people here with other diagnoses - one has palindromic rheumatism and there is absolutely no forum about that. If it turns out it IS a spondyloarthropathy, they can present like PMR and even mimic GCA. One past member of one of the forums got a diagnosis of PMR but later really struggled to reduce pred. She also developed tongue symtpoms that are sometimes seen in GCA. Her rather poor rheumy disagreed but eventually sent her to Prof Dasgupta who said yes, she had had GCA but pred wasn't now appropriate, just enough for symptom control. But he wouldn't let her have enough to manage the pain. She eventually went to Prof Mackie in Leeds who was baffled - until the patient mentioned severe night time back pain. An MRI showed ankylosing spondylitis - anti-TNF medication worked a miracle. It can cause reduction of carotid blood flow - and symptoms similar to GCA.
Lots of the things we discuss are related to the disability and the effects of medications - doesn't really matter what the actual diagnosis is.
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