I had a telemedicine visit with my rheumatologist today. Since I've shared my history and asked for advice here in the recent past, I thought I'd share how it went.
The visit went almost a half hour (one of the things I like about my rheumatologist is that he doesn't try to rush my visits). I shared with him what I've learned from this forum, and he is ok with the "slow taper and go back to a previous level if needed" advice I've learned here. If he had opposed it, I was going to look for a second opinion, but since he is amenable to the approach, I thought it was valuable to have a local rather than a distant rheumy.
After discussing options, he felt that, since my major symptoms are those of PMR, not the psoriatic arthritis flares of the past, I should go back to being treated with prednisone. What makes my case a bit different than just PMR alone is that my RF and CCP values are elevated, indicating RA, yet I don't have any joint or limb involvement (my pain and stiffness are all located hips to shoulder). The RA markers and the psoriatic symptoms in the past was why he had proposed MTX.
I go back on prednisone tomorrow (10mg/day, since I was symptom free at that level) and will see him again in six weeks. No tapering until we meet again. I should call him if I have any significant changes before then.
Written by
benhemp
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Can I ask what symptoms differentiate between a Psoriatic and a PMR flare?
My Psoriasis is confined to my feet but has flared horribly during the hot weather, my feet look dramatically scalded. I am free from PMR symptoms and being treated with Tocilizumab and tapering, quite quickly from 10 mgs Pred. Thanks.
I think the symptoms can overlap, but there are differences. My most obvious psoriatic flares have involved dactylitis (sausage digits); in my case sausage toes, over twenty years ago. The first time, my large toe on my right foot swelled to twice its size, then returned to normal after about a month. Several months later, the same thing happened to the large toe on my left foot, but this time it took much longer to return to normal. Dactylitis of this sort is a classic symptom of psoriatic arthritis.
My psoriatic arthritis case is atypical, however, because other than the two already-mentioned sausage toes, all of my psoriatic flares have involved muscles, not joints, and because I have never had psoriasis. Most of my psoriatic arthritis flares, but not all, have been in my legs, but as years passed some have been in my torso. In each case, I would get a sore muscle group that would hurt for several months, then it would return to normal and I would have a period without pain anywhere. Then the pain would reappear in a new location. In the past year, I had chest wall pain known as costochondritis (inflammation of the cartilage of the rib cage), which is also sometimes caused by psoriatic arthritis. These flares were not symmetric; the pain location may be left thigh, later right calf, later one of my butt muscles, etc.
My PMR symptoms, however, are more symmetric and always from the hips up (not in the legs or arms), especially in the shoulders and the base of the neck, and they involve much more stiffness. The pain increases the longer I am in bed, and I am most stiff and painful for an hour or two after rising. And since my PMR started, the pain, stiffness, and fatigue seem to be there every day (no periods of no pain, except for when my prednisone level was 10mg or above; I have been off prednisone for the past four months, and am restarting now), although the levels can be higher or lower.
This is my experience and understanding of the differences between the two types of flares. I hope it is helpful to you or someone else!
Thank you for your very helpful post. It is clearer than any doctors have been. It must have been difficult to get a diagnosis. I had sausage toes once in Australia. I don’t really associate it with joint or muscle pain, just the burning sensation of the Psoriasis . The occasional use of a weak steroid cream clears it up quickly.
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