Rheumatoid Arthritis?

[Offsideinzaghi]

Can Polymyalgia Rheumatica progress to rheumatoid Arthritis?

After being diagnosed with PMR over two years ago my rheumatologist now thinks that it has progressed to rheumatoid Arthritis.

Has anyone else had this?

[PMRpro Ambassador]

I doubt it "progresses" to RA since the PMR we talk about is fundamentally a vasculitis and RA is an arthritis, a joint problem. Have they found any evidence of joint erosion or specific blood tests to back up the claim? At a guess (and I apologise if I am misjudging them) they ascribe to the myth that PMR lasts 2 years and if it is still around it can't be PMR.

What is far more likely (though no doubt they won't admit it) is that the original PMR was misdiagnosed and should have been an inflammatory arthritis with a polymyalgic presentation or something similar. It wasn't his fault because research has looked at whether PMR and LORA (late onset RA) have any identifiable differences in the early stages and there aren't. But PMR isn't the disease - it is the name used for a set of symptoms that can be due to a whole range of underlying disorders inclusing arthritides and even some cancers.

But yes, happens to people a fair bit - but it isn't always the case.

[Offsideinzaghi in reply to PMRpro]

Thanks for your reply. I’m at a but of a loss now to know what to think! I was tested for RA and the result was negative but the consultant said that can sometimes happen 🤷‍♀️ He himself has said that he’s not 100% sure it is RA but does think there is something else underlying which the steroids are masking so he wants me to be off steroids.

[PMRpro Ambassador in reply to Offsideinzaghi]

Ask him about his views on 2 years as a limit for PMR!

Depends what he tested - there is no direct test I know of for RA except demonstration of erosions in joints. Rheumatoid factor is pretty useless - you can be positive and perfectly healthy and negative and have what is called sero negative RA. ACCP is a better test - in that if it is negative the chances of it being RA are very low while it is positive in 75% of RA patients and if it is positive it is a predictor for development of RA in later life.

medlineplus.gov/lab-tests/c...

It MIGHT be RA - but I think it is far more likely it is PMR of a sort he probably doesn't believe in! It isn't simple, homogenous disorder. There are several versions - including a couple of longterm sorts.

[Amkoffee in reply to Offsideinzaghi]

I hande to agree with PMRpro. My rheumatologist kept insisting that I had RA dispite the negative test results. But since I've now had an MRI which showed no evidence she has backed off of that idea.

[Lonsdalelass in reply to Offsideinzaghi]

Similar to my situation. My rheumatologist nurse specialist thinks I am now presenting more with OA!

[SheffieldJane]

Whatever or whichever it is, I bet you are offered Methotrexate, the Rheumie’s favourite.

[PMRpro Ambassador in reply to SheffieldJane]

It is, to be fair, the worldwide first line approach for inflammatory arthritis!

[Maisie1958]

Hi,I was diagnosed with PMR in 2015, “managed” by GP. Tiny doses of Pred worked beautifully until 18months ago when got aches in joints and extremely stiff and sore knees, feeling generally awful only responded to increased prednisolone and not nsaids etc. GP said “wear and tear, PMR only lasts 18months, gave useless co-codamol. Saw rheumatologist for first time, lots of MRIs , X-rays and u/s and bloods showing not much at all, only increase in ESR and CRP when I came off prednisolone - even then my worse symptoms seemed more polymyalgic - shoulder and thigh muscles and night sweats. Transferred to her NHS list and started on MTX last August, weaning down from my new high level of 5mg Pred slowly. Took my last half mg early May and feeling fine. I have sero-negative inflammatory arthritis with polymyalgic onset as diagnosis on my clinic letters now, I’m not sure what I have- seemed classic PMR with a bit of LVV (scalp pain, episodes of jaw claudication, tinnitus etc) that responded beautifully to almost homeopathic doses of prednisolone. No joint erosions or RF or anti- Ccp but responded great to MTX , though it’s still extremely early days I know.

Anyway after that ramble that was all about me, sorry, just wanted to say I think it’s worth while getting someone to take a fresh look and not to dismiss out of hand any new treatments they may suggest. I was very against taking MTX , now very happy that I actually feel well again. 🤞

Hope you get sorted. All the best.

[Offsideinzaghi in reply to Maisie1958]

Thanks for your response. Helps to hear other people’s experiences.

[piglette]

Some of these doctors do talk rubbish. Rheumatoid Arthritis and PMR are both autoimmune diseases and they say if you have one auto-immune disease you are more susceptible to get another. The two are quite often diagnosed incorrectly too. I have known a couple of people diagnosed with PMR and it was then discovered they had RA.

[Offsideinzaghi in reply to piglette]

Thanks for your response.

[Offsideinzaghi]

Thanks for your comments. Really helpful .

[Maisie1958]

emjreviews.com/rheumatology...

[Gottarelax]

I developed exactly the same symptoms as my mum and sister. They were diagnosed PMR (and still struggling with it after 40 and 10 years respectively). I had anti-CCP antibodies at first consultation and have been diagnosed RA. I think that had I been seronegative for RA, I would have been diagnosed PMR for sure. Mum particularly seems to have RA like symptoms like finger deformity but has never had her hands or feet x-rayed. My rheumatologist calls mine Myalgic onset RA which apparently has a PMR like onset.

[Sandradsn]

After 4 years on pred for pmr,my gp was wondering if it wasn't pmr at all and maybe RA."Maybe I was wrongly diagnosed as it shouldn't last over 2 years"🙄She did blood test..negative for RA.

[mickam]

My understanding is that PMR can lead to RA. I was diagnosed with PMR around 8 years ago and after 4/5 years was told I had RA. The PMR was confirmed by2 different consultants and the RA by 3 consultants.

[DorsetLady PMRGCAuk volunteer in reply to mickam]

Not sure it’s proven that PMR can lead to RA as such, but it’s widely understood that if you succumb to one autoimmune disease it’s likely you MAY suffer from another. There are many on here who have more than one..

[PMRpro Ambassador in reply to mickam]

You can have both - and a load of other things. But the most likely reason there is this impression PMR "leads to" RA is because there is no feature that enables them to distinguish between PMR and a polymyalgic onset of LORA, late onset RA. the only possible options seem to be either the way in which the patient responds to pred, the "shape" of the response appears to vary a bit but it isn't 100% accurate, and if a patient has a positive ACCP test it is very unlikely to be "just" PMR and there is a high chance they may develop RA in the future - but again not 100%.

Polymyalgia rheumatica isn't the disease as such, it is the name given to a set of symptoms that are due to an underlying disorder. Some are autoimmune in origin with quite varied targets but it also includes some cancers and a few other things. The PMR diagnosis we talk about here is a diagnosis of exclusion - you rule out everything else it might be and look at how the symptons respond to corticosteroids, and then you can think it is PMR,

[cranberryt]

My theumy argued that hecause I was under 50 at dx, it was impossible for me to have PMR therefore it must be sero negative RA and that in younger people a diagnosis of PMR is probably incorrect and should be RA all along. I had xrays and a gzillion blood tests with the only abmornal result being elevated ESR. My symptoms aligned perfectly with the PMR rubric while it obly matched RA about 50%. I left her after a year and went back to my GP but she was still convinced it had to be RA. I am down to 2mg after 3 years and my GP is a little anstsy about me still being on 2mg and my ESR has started to rise so he is sending me to a new rheumy in town for a consultation and we will see what he says (in a few months when I can get in.) They didn’t do any scans or anything to dx the PMR like I see some people getting nowadays.