Can PMR pain migrate (move) from one area to another?

[pmrusa]

Hi all (from Nashville, TN - USA)

Firstly - this site is invaluable for PMR folks with my rheumatologist(s) stating the same. I was diagnosed 2 years ago this month and my journey has been typical with a couple flare ups during prednisone taper (started at 25 mg and stair-stepping to a low of 2 mg.) and currently stabilized at 4 mg for the long term.

Now my question: has anyone experienced their PMR pain move from one area to another? For example - my right shoulder was the worst during the first year, but now my right shoulder is painless with the soreness and limited range of motion in my left. What's more - I've had an asymmetry of discomfort after the first year with pain on left side shoulder / right knee, etc.

Throughout I've had pain to a lesser degree with the usual hip/pelvis pain until two months ago with pain now only in my left shoulder and (oddly enough) rib cage area. Has anyone else had pain in the rib cage area? Specifically, in the external intercostal membrane? Could this have the same synovial membrane effect?

I understand everyone is different and our attributes from this condition unique. But the one common theme? It sure does hurt.

I've been lucky at 62 that I've returned to running and back to several miles a day. If all goes well and no setbacks, I'm looking to do a half-marathon in April 2021 (Covid permitting).

Thanks again for everything. You guys are the best!

Respectfully

Matt Peters - Nashville, TN (USA)

[PMRpro Ambassador]

Maybe not quite the same thing but I find every time I have a flare it is a bit different!

Assymetrical pain can also be due to myofascial pain syndrome - more people with PMR tend to develop MPS and there is a ink in the pathology

jrheum.org/content/46/12/1552

[pmrusa in reply to PMRpro]

Thank you very much indeed for that. MPS could explain a lot and is consistent with my pain points. At the very least, it gives me something of substance to discuss with my docs.

Thx!

[benhemp]

My rheumatologist and my reading both say that asymmetrical pain that moves around and costochondritis (inflammation of rib cartilage) are known features of psoriatic arthritis. (I have experienced both, and am diagnosed with both PMR and psoriatic arthritis. In my case, my psoriatic arthritis is atypical in that, gratefully, I have no psoriasis and no affected joints.) Might be worth investigating.

[Manchild in reply to benhemp]

Curious, but how did your doctor arrive at the dx of psoriatic arthritis, as my symptoms seem similar?

[PMRpro Ambassador in reply to Manchild]

Sometimes it is a fixation! The second rheumy I saw was desperate for it to be PsA even though I had never had any psoriasis and apart from blood markers my symptoms were absolutely classic PMR. There are some who think PMR is beneath them ...

[benhemp in reply to Manchild]

In my case, from my teens I suffered sporadically with a muscle pain that would appear somewhere in my body and then disappear after awhile. These moved around (they went somewhere else the next time); and the problem was only located in one place at a time. They would last for some months and then disappear for a longer period, then re-appear somewhere else; nothing symmetrical about them. My GP didn't know what to make of it, but labeled it "connective tissue disease". At age 40 I also experienced a painful blowup (enlargement) of my right foot's big toe that lasted one month, then went back to normal; several months later, the same thing happened to the big toe of my left foot; that one also went back to normal but it took much longer. (These digit flares are called "sausage digits" and a feature of PsA.) I was prescribed indocine for these digit flares and the muscle pains, and it helped quite a bit; I'd take it for a 1-3 days and things would be good again for months. When the flares became more frequent and the relief less complete, my GP referred me to a rheumatologist who examined me and found that I also have some pitting of my nails (another PsA feature). That's when I received the PsA diagnosis. Some years later I had two or three months of costochodritis (nasty!); that too is a PsA feature.

My PsA is atypical in that I have never had psoriasis or joint involvement/disfigurement (other than the two sausage toe incidents).

At present, my symptoms are definitely more from PMR than from PsA. The rheumy says whichever is stronger will mask whichever is weaker. That certainly seems to be the case for me. But sometimes I can detect some of the PsA type of pain coming through (particularly, pain in my legs).

[scrambledegg]

Regarding pain in the rib cage area, when I try and reduce from my current dose of pred. one of the first indications the inflammation is returning is all over rib cage pain when I get out of breath or even just an extra deep breath

[Amkoffee]

Well I'm certainly impressed by you. I suspect what you may have in your rib cage is an intercostal muscle strain. It can be extremely painful I can attest to that. But the good thing is, if that is what is nothing you then it is temporary.