PMR/Pred/Psoriatic Arthritis....?

[CornishCliff]

Hello.

I was diagnosed in Aug 2015 with PMR. Prescribed 15mg which did the job. I spent the next 5 years working my way off. I'm now Pred free for 12 weeks or more. All seems good. (Obviously the ravages of all of this are there in their own little ways).

However... I had developed some nasty nail markings (during pred/pmr times) etc., and was given fungal nail treatment. This doesn't seem to have really done much (slight improvement lately. Due to coming off pred?)

I finally was sent to rheumatology and the fellow there has decided to treat me with Methotrexate for Psoriatic Arthritis (which does make sense regarding my fingers/nails). Which is okay by me I guess. However, he also commented that I may not have had PMR (I know......) as Psoriatic Arthritis can present extremely similarly.

A question, if I may.. Has anyone experience with misdiagnoses of Psoriatic Arthritis, had it in conjunction with during or after PMR? And the prognosis for successful treatment of PA by Methotrexate? Anyone?

Thanks..

[PMRpro Ambassador]

There is someone else currently having their treatment changed from pred for PMR to methotrexate for PsA and over the years there have been one or two others.

If you want to contact others with a PsA diagnosis you would probably do better on the NRAS forum:

healthunlocked.com/nras

or Beyond psoriasis

healthunlocked.com/beyond-p...

although the second is relatively new and small and nothing like as active as we are.

[PMRpro Ambassador]

PS - this might be helpful:

psoriasis.org/understanding...

This

ard.bmj.com/content/79/6/700.1

is a heavy read but there is a summary of the Recommendations just after Figure 1.

This, on the other hand, is a bit basic:

nhs.uk/conditions/psoriatic...

Patient.info is usually pretty good for leaflets and used to have very good forums until website changes made it next to impossible to use!

patient.info/skin-condition...

And this site is usually good:

versusarthritis.org/about-a...

Pred wasn't wrong as such - it is often used too but there are now other drugs to move on to that work better or when methotrexate doesn't cut the mustard!

[CornishCliff in reply to PMRpro]

Thanks.

[SheffieldJane]

I have significant Psoriasis on my feet and Psoriatic arthritis has been mooted. I have however, been text book PMR and very responsive to Prednisalone. Do you just have the nail markings?

[CornishCliff in reply to SheffieldJane]

Yup. Just nails. Stained/curled/lifting from bed. Stiffness, pain only from 1st joint up. Pretty much classic description if PA.

[SheffieldJane]

Yes it is. I have psoriasis in my nails and they do that. I hope it isn’t PA . I have always kind of dreaded Methotrexate but some people get on perfectly well with it.

[Jooster]

Thank you for that information CornishCliff. I had a diagnosis for PMR last year and am on Pred for that. Have been newly diagnosed with psoriatic arthritis this week and now just waiting for the doctors to organise bloods and Xrays and treatment plan medication. I feel I am doing quite well on tapering the steroids as now down to 12.5mg from a start of 20mg. It's a long journey isn't it?

[regan2]

hi cliff like you I started PMR Aug 2015 and am down to 1.5mg. I have taken Methotrexate since July 2019 (Not for PA though) I have had no side effects, but blood tests for liver function are necessary and you have to take Folic acid the day after. Good Luck

[DottieCat]

I have PsA too, but with very little psoriasis. Was injecting methotrexate subcutaneously every 7-10 days. Side effects feel rubbish for me for 2 days after injection but then fine. I had to stop it to have covid vacinnes. Got infection after first jab in feb so couldn't get second til last week. Planning to go back on methotrexate after third covid jab. I was scared of methotrexate but imho it causes me less problems than the pred.

[SouthHams]

Hi Cliff, I was diagnosed with PMR a couple of years or so ago which was treated with pred, a year or so later I was getting pains in one or two fingers and 'sausage' finger (I have had psoriasis for many years, at least 30, and my nails have been pitted, lifting etc for probably 10 years now), my doc referred me to a rheumatologist for tests and PA was confirmed.

I have just started Methotrexate and pred, the former once a week and increasing as the latter reduces, also folic acid. I am slightly concerned about taking MTX and watching carefully for side effects, but I am going to be monitored closely and I will follow the medication plan to the letter. I am hopeful that the MTX may help to reduce my psoriasis as well as treat the PA.

My rheumatologist suggested the diagnosis of PMR was probably incorrect as he suspects I have had PA for a number of years.

I see you posted 6 months ago, is there an update on your condition? Good luck with your treatment.

[PMRpro Ambassador in reply to SouthHams]

If you had a history of psoriasis and the nail effects were obvious - the first thing to think of with a presentation looking like PMR is polymyalgic presentation of psoriatic arthritis rather than "just" PMR . Even a GP should know that!