How to tell if pain is PMR or arthritis

[Artwatercolour]

My GP SAYS ARTHRITIS pain is bone and heat at the pain location AND. PMR is muscle pain. Is this correct. I have osteoporosis. After I am up and about pain is just about gone. My Neurologist thinks my pred is way too high 17.5 and due to possible bad side effects I need to reduce weekly. I know what to do re reducing from the help I get from this forum. ..which I am in the process of doing. She said the pain is probably arthritis not PMR thus my question. Karen

[DorsetLady PMRGCAuk volunteer]

Osteoarthritis is joint pain, sometimes with heat but not always (not for me anyway) - although that could be rheumatoid arthritis - see link for more info - and picture as example - versusarthritis.org/about-a...

PMR (by causing inflammation in your blood vessels and restricting blood flow) affects the muscles surrounding your major joints.

If you have both it’s sometimes difficult to tell what pain is what, but from my own experience OA pain was masked by higher doses of Pred, and didn't reappear until much lower than 17.5mg.

Knee

[Artwatercolour in reply to DorsetLady]

Thanks for your prompt reply. Since I have not had a recent diagnosed re arthritis I think I’ll ask dr for some tests. It’s just hard to reduce any know what the pain is…PMR or arthritis

[DorsetLady PMRGCAuk volunteer in reply to Artwatercolour]

Yes ask for more tests - but as I say, at your level of Pred, my guess would be be PMR pain. Would be interested to know

[HappyDiamonds in reply to DorsetLady]

Thats very interesting thank you, I don't have heat with pain either. Just to add I had no idea at all I had Osteoarthritis, not even a twinge until I tapered to below 15mg from 60 for GCA. Then it hit me like a ton of bricks, spine, hip, pelvis, knee. The Trauma doctor thought it was PMR and upped the steroids to 20mg but it didn't help. Rheumy said it had all been masked by Steroids, so within 16 months of diagnosis and starting steroids I developed Osteoarthritis and Osteoporosis.

[DorsetLady PMRGCAuk volunteer in reply to HappyDiamonds]

You may well have already had OA - most people over 50 have it to some degree - if it’s mild and there’s no pain you probably don’t realise..and why would you?

I did have it in left knee way before GCA, but it was a niggle, nothing more really. Problem is, it deteriorated whilst on high doses of Pred without me realising it, and once I got down to low teens it became painful again.

I never blamed the Pred for my OA, it’s in the family anyway, and my sister had it a lot worse than me, and she never took a single Pred tablet. She was wheelchair bound….fortunately I’m not, but have had (one of each) knee, hip & shoulder replaced…

Fortunately never developed osteoporosis either, although was in the ‘most likely to’ group - hysterectomy at age 37, so I did take AA for 4 years.. and still taking VitD/Calcium supplement as suggested in last DEXA scan…..after finishing Pred.

[PMRpro Ambassador]

I do wish doctors wouldn't just chuck the word "arthritis" around without saing what SORT of arthritis they mean.

carolinaarthritis.com/the-t...

There is a major difference between osteoarthritis and the inflammatory arthritides. The link is purely that they cause joint pain and damage.

PMR certainly doesn't cause heat in a joint - and it doesn't permanently damage the joint although it does affect the synovium, the lining of the joint. PMR affects the soft tissues around the joint and that leads to stiffness and pain.

Who decided what you had was PMR originally? And who then started you on 50mg? By doing that they have really muddied the water - one indicator is that PMR responds well to a moderate dose of pred (up to 20-25mg). A lot of other things would improve with 50mg - and in PMR it is NOT required. However, since you are on the way back down from a possible GCA dose, I don't really know why the neurologist is so iffy - you will get back down if it wasn't GCA.

Why do you see a neurologist for PMR symptoms? I can see the point for GCA though they are really not the usual specialist - rheumatologists are a far better option.

[piglette]

If you have PMR, reducing weekly is definitely a no no. Just asking for problems. I think your neurologist has very little idea of PMR or steroids if it comes to that, in my opinion. I know friends who are medical consultants who really know nothing about steroids so I think it may be a common problem.