PMR vs OSTEOARTHRITIS : How do you tell if pain is... - PMRGCAuk

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PMR vs OSTEOARTHRITIS

Artwatercolour profile image
Artwatercolour

How do you tell if pain is PMR or osteoarthritis

47 Replies
DorsetLady profile image
DorsetLadyPMRGCAuk volunteer

It a bit difficult sometimes, especially at lower doses, which I guess you are by now. What dose are you on?

Are pains bilateral, or just in one joint? if just on joint, more likely (although not always) to be OA.

Do other painkillers including gels help? If yes, again more likely to be OA.

I have followed this forum religiously and learned heaps. I have been reducing slowly 5 then 4 3/4 then 4 1/2 then 4 1/4 then 4. All done according to reduction recommended on forum Then at 4 I woke up with my sides of hands hurting + the side of my left arm ESPECIALLY around the elbow. It eases once I’m up and around. I have not tried any pain pills. I now trying DEAD SLOW yesterday and today taking 10. Will do for 5 days then I think I’m supposed to go back to where there was little or no pain which would be 4 1/2? What do you think am I moving forward ok? I do have osteoporosis in my hip and thought maybe it was moving in other spots of my body. But instinct tells me it was a flare. DARN

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer in reply to Artwatercolour

Sounds more like a flare....and maybe 4.5 or 5mg is what your illness actually needs at the moment...won’t be forever, but it is just now.

If that’s the case, then no matter how you reduce your body will struggle. Maybe stick at 5mg for a month or so, and then try again...

Thanks for reply. How long should stay at 10? Today will be day 3 on 10. Still have pains maybe not as severe.

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer in reply to Artwatercolour

Anywhere between 7-10 days depending on how you feel, then drop back down to 5mg - either in one drop, or 2 stages to 7,5mg initially for a few days and then to 5mg.

Tonight the left arm elbow pain is much better but my left hand is burning. Both hands somewhat stiff. So that I understand I’m continuing with 10 pred for 5 to 10 days - does this mean this flare pain should stop ?

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer in reply to Artwatercolour

If the hand pain is caused by your PMR then yes, certainly by day 10. If it hasn’t, then you may need reconsider what it is!

Thanks. This morning hand much better just a little stiff.

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer in reply to Artwatercolour

Ok, well stick at 10mg a bit longer ...hopefully will sort it.

(Flare Plan) I spent 10 days on 10 mg and now on 7.5 and will reduce down to 5 soon and stay there for about a month. Then start reducing by .5. Thanks again for your support as well as all who responded. This site is so very helpful - don't know what I would have done with out it.

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer in reply to Artwatercolour

Good luck.

PMRpro profile image
PMRproAmbassador in reply to Artwatercolour

Remember, you aren't heading relentlessly for zero, you are looking for the lowest effective dose and that may well be 5mg for now. It doesn't mean you won't get lower, just not yet. Often a rest from reducing for a few months helps - it lets your body catch up and then it goes OK for a while again. You do have the potential aches and pain of poor adrenal function to think about too now.

Thanks. Yes I think a month to rest from reducing sounds sensible.

PMRpro profile image
PMRproAmbassador

To some extent it must depend on where the pain is. But as DL says, painkillers often deal with OA, they won't help PMR.

I will try pain pill and see what it does.

Pain pill did not help

Is that good or bad? More pred needed?

I think it has helped me identify the pain is pred NOT OA. While on my holding pattern of 10 mg for up to 10 days it seems each day is getting less painful. Evenings the worse. What a journey. But thankfully have this Forum.🙂

In my case I find the pain very different, with osteo I find that there is sharp pain round the joint area while with PMR there is more of an ache of the muscles in a much larger area.

Thanks for reply. Does the osteo sharp pain eventually go away?

Osteoarthritis has a spell of inflaming and causing pain and damage to a joint. Then it settles down and doesn't hurt as much, if at all really, but can leave behind a joint that doesn't work as well as it used to. And that may not be the only time that joint flares. I was originally diagnosed with OA at age 40 (just turned 74) because of my fingers which were developing swollen and slightly painful joints. All my fingers are knobbly now, Unfortunately OA didn't end there (and I don't think it actually started there), and it is so much worse when it gets into larger joints. Another issue I have is arthritis in my spine and because of all the nerves associated with the spine I get a lot of referred pain which, with PMR apparently hanging around, can be quite confusing, not to mention miserable. I have taken glucosamine for many years, and remained physically active, but the past year has been another story altogether and I am now in pretty much continuous pain. This pain responds to aspirin and even, to some extent, to tylenol, so can't blame PMR. But it is making it more difficult to determine a correct dose of pred. I think every medication you can take for pain has a deleterious effect upon the joints so in the end it's counterproductive to take painkillers on a regular basis to deal with OA, and I believe even pred is bad for the joints, certainly cortisone shots are.

Thanks for your eply. I have not tried taking pain pills - will do and see if pain eases. Actually this morning the pain in my elbow is less - so once again not sure if it's because I've increased Pred due to the flare or its just ole osteo resting....

Nsaids interfere with cartilage renewal, as I think so does pred, unfortunately. I had a good day yesterday - because I had a headache the day before which wouldn't go away so I had one dose of tylenol and later a dose of aspirin, and felt really well when I got up yesterday - which I wanted to credit to my 2 am 5 mg of pred. But today was another story. Yes I could take painkillers all the time, but if I had, I would probably have needed more than one joint replacement by now.

It depends where it is, as you can always have a joint replacement. Pain killers are also another option. It does vary though. Exercise can help and massage. My mother had it in her hands and they totally seized up into claws and she said the pain went away.

HeronNS profile image
HeronNS in reply to piglette

Hands totally seizing up into claws sounds more like rheumatoid arthritis doesn't it?

piglette profile image
piglette in reply to HeronNS

It wasn’t rheumatoid, it was osteo. I know what you mean about rheumatoid, fingers sort of bend over. Apparently it is getting a lot better for people due to modern drugs. I was a trustee of an arthritis charity and several of my friends from there had rheumatoid with their fingers bent sideways. My godmother had it too.

HeronNS profile image
HeronNS in reply to piglette

I had a teacher with the bent over fingers, that would be sixty years ago. She must have had so much trouble holding the chalk!

piglette profile image
piglette in reply to HeronNS

It is incredible how some people manage. This is a photo of a tortoise with arthritis. I feel for him!

Arthritis
HeronNS profile image
HeronNS in reply to piglette

I think I saw this animal on a news program the other day! His wheeled harness has given him a whole new lease on life!

piglette profile image
piglette in reply to HeronNS

You would never have thought a tortoise would get arthritis

Constance13 profile image
Constance13 in reply to piglette

That's about the way I move!😏

HeronNS profile image
HeronNS in reply to piglette

I love the way you casually say "you can always have a joint replacement"! Maybe, maybe not. And in some places in the world the wait can be years long.

piglette profile image
piglette in reply to HeronNS

I know how long you have to wait. I waited several years on a waiting list with an incompetent GP in my case and an NHS waiting list. I decided to go privately the second time to jump the queue but Covid came along and so I had to wait again, only it was months this time. I sit and thank God I was lucky enough to have it done last year when I think of the poor people suffering in the very long queue.

I have OA in my thumbs, wrists and toes. I know just where it is, which joints it affects, and don’t have pain caused by pmr in those places! I do think though, that OA was, in my case, masked and perhaps helped by large doses of pred! I only realised my toes were so bad when I was below 20mg pred but that may have been coincidental of course! Now on 4mg, started on 16mg. Consultant realised I was automatically walking on sides of my feet to avoid big toes taking any pressure due to pain! GP diagnosed inflammatory arthritis. I do now have quite a bit of pain in my hips, though it’s not constant, and you are right now I don’t know if that is OA or pmr! Um trying to help here...the pain is sharper with my OA, more the type of pain that makes you shout OW! And sometimes other unprintable words. The pain I get with pmr is constant, weighs me down, unchanging and not ceasing at all until I give it the right dose of pred. Just pressed my hip bones and that’s an ‘oh my word that’s nasty’ pain not a bone wearying ever present pain that I get with pmr. Example for me.., my shoulders are really bad with pmr but it’s like a huge huge weight bearing down upon them, constantly and the fatigue and brain fog tell me I’m overdoing it or not taking enough pred. Sorry, I hope this helps a bit it is hard to put it into words. Take care, S x

PMRpro profile image
PMRproAmbassador in reply to Pixix

"GP diagnosed inflammatory arthritis" - how? And what has he done about it?

Pixix profile image
Pixix in reply to PMRpro

Did specific blood tests and referred me to consultant, who I saw within ten days, despite Covid holdups, and she referred me to two other departments in the hospital and will see me again in six months or earlier if I feel the need and ring her department. I thought that was a good response but perhaps you disagree or think he should have done something different? S x

PMRpro profile image
PMRproAmbassador in reply to Pixix

Just wondered - did the specialist add medication on top of pred?

Pixix profile image
Pixix in reply to PMRpro

Ah, well I’m already on time release Tramadol and paracetamol so can’t take ibuprofen or similar. But my doctor prescribed morphine in liquid form and time release tablets. Amazing to think I’m still in pain despite this arsenal really! I have been taking tramadol for 12 years, but when I miss taking it I really know it (for other issues). So I’m fairly well covered!! Thanks, S x

PMRpro profile image
PMRproAmbassador in reply to Pixix

My point is: inflammatory arthritides have the potential to destroy joints and purely pred plus painkillers isn't the way to manage them. OA is not usually classed as an inflammatory arthritis.

Pixix profile image
Pixix in reply to PMRpro

Waiting to see how next three months goes as I don’t want to start the drugs involved in RA. I want to see if I can get off pred in next three months and then see what else is definitely happening. I am down to four, have been at 2mg for 3 weeks but not good so back up a bit again and taking Mrs Nails advice to start using half a tablet to taper by 0.5 pred, if necessary. OA needs pain relief as do car crash injuries, benign spinal tumour and other items. It’s been my first episode of inflammatory and I’m waiting to see another specialist in the next month, too, then bloods will be repeated. Thanks S x

DadCue profile image
DadCue in reply to Pixix

"I do think though, that OA was, in my case, masked and perhaps helped by large doses of pred!"

I know this was true in my case. I had been diagnosed with inflammatory arthritis 20 years before PMR was diagnosed. I thought I was managing things well with the leftover prednisone that my ophthalmologist prescribed for uveitis. No rheumatologist was even involved but that was mostly my fault.

When a rheumatologist was eventually consulted there was some initial confusion about whether my symptoms were being caused by inflammatory arthritis or PMR. My rheumatolologist didn't exclude either one and decided I had both.

About 8 years into my treatment for PMR, I developed severe radicular leg pain complete with numbness, tingling and severe right leg weakness and foot drop. When a spine surgeon reviewed the MRI, he described it as the worst spine he had even seen. My comment to the surgeon was that I didn't even know that I had a bad back.

Ultimately, I took a large dose of prednisone and didn't have the urgent surgery that was scheduled because the pain stopped. The advise I received was to let pain be the deciding factor about when to proceed with surgery. That was 5 years ago and I still haven't done the surgery.

One thing I learned about inflammatory arthritis is that the damage being done starts to look just like severe osteoarthritis. Also, prednisone helps the pain but doesn't prevent the damage.

Pixix profile image
Pixix in reply to DadCue

Very interesting, thank you so much for sharing that information! My GP says I am 'complicated' because I have so many different things that are an issue, which makes it difficult to see which part is causing what symptoms, and then, also, what each drug is doing - which bit is it helping etc! I wish I could be straightforward again, but realise it's unlikely now! I, too, could be a candidate for back surgery - they are monitoring my tumour, but it is benign, and if it doesn't cause problems, then we shall just let 'sleeping dogs lie'!! The symptoms that lead to the discovery of the tumour were actually from another disease altogether! It's a good life it you don't weaken!

Artwatercolour profile image
Artwatercolour in reply to Pixix

Thanks for sharing

Okay, so your question was top of mind when I got up this morning. I went to bed last night in fairly extreme discomfort. At 2 am I took 5 mg pred. I got up at about 7 and did a kind of full body pain check. I can pretty well guarantee that I had no PMR niggles. However I have a really painful shoulder and a really painful hip, and my fingers and knees feel stiff. Pixix 's description of how PMR seems to have a weight to it is really quite good. OA can restrict movement and action because of pain and stiffness, but it's not like something holding you in a grip which makes it seem like your limbs are too heavy to move.

Thank you for asking this question because it's made me think very carefully about my own situation because I was afraid to taper pred any more. I think perhaps it is okay. Even last night when I went to bed in pain I was thinking, I don't feel that PMR weight. I know it's a strange way of putting it, but PMR feels really toxic, and although OA is unpleasant and debilitating and even at times excruciating, it feels "clean" by comparison.

Pixix profile image
Pixix in reply to HeronNS

I understand your toxic and clean comments! It’s hard to know where pain comes from when you have lots of issues! I have fibromyalgia as well so that confuses things, too!

Bcol profile image
Bcol in reply to Pixix

Morning all, I've only just had time to read this thread and it brings home to me how lucky I am, compared to others. with only having to cope with OA and PMR. I Just wanted to add that I think your ( Pixix) description of the difference between OA and PMR is absolutely spot on. My OH has Fibromyalgia so can totally understand how that must confuse things regarding pain. I'm at the end of my 2nd week of tapering from 7 to 6mg and will be interested to see if my OA pains become more noticeable.

Pixix profile image
Pixix in reply to Bcol

Thanks! I really do have to try and sort it out or I would constantly try taking more pred or otherwise be taking more painkillers! I think the one constant I find is that walking, for exercise and fun, helps both fm and pmr in my case! I think I noticed it from 5mg downwards really (then wondered if it was to do with adrenals!) I got down to 2mg but quality of life was insufficient for me and now I’m on four but planning to go to 3.5 (thanks to Mrs Nails for suggesting it) as soon as I find time to halve some! S x

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