Arthritis, PMR or both.

[Hughie1951]

I’ve been on this journey for nearly 3 years and am down to 1.5mg pred. I still get shoulder pain but it manifests in a different way to when I first got PMR. I had shoulder problems for some years before I got PMR. I found it difficult to tie up my blood parameters, which were fine, with the shoulder pain. I wondered whether I was dealing with two conditions manifesting as shoulder pain. I got MRI on both shoulders. This revealed bilateral acromio-clavicular arthritis and a mild labrum tear in the right shoulder. On this basis I had intra articular injection of steroids int th AC joint. The results were initially amazing but didn’t last long. If I do anything involving my shoulders they do hurt more for a few days before quietening down again. The question is, is this still PMR or shoulder arthritis or both. The big question is, do I dare carry on reducing or not.

[DorsetLady PMRGCAuk volunteer]

Hi

If I do anything involving my shoulders they do hurt more for a few days before quietening down again

If the pain subsides without taking more Pred, then that would indicate it is more likely to be arthritis -if it were PMR, then it would continue to increase over time.

Do you take any painkillers or uses a topical gel when they are at their most painful?

And do you have any other symptoms that could indicate it might be your PMR?

[Hughie1951 in reply to DorsetLady]

Thanks. Just wanted reassurance. I think I am dealing with arthritis rather than PMR. I think the latter may be in remission Sioux I’ll try and get off pred if I can. I do take ibuprofen twice daily as I’ve also got torn and degenerative menisci and arthritis in both knees. I do take lanoprazole to mitigate the gastric effects of pred and ibuprofen.

[PMRpro Ambassador]

"How do you treat acromioclavicular arthritis?

Initial treatment of AC joint arthritis is non-operative and includes activity modification, physical therapy, non-steriodal anti-inflammatory medications (NSAIDs), and local AC joint injection of anesthetics or corticosteroids "

The original steroid injection was not a cure - but part of a management strategy and that needs to be continued.

[Hughie1951 in reply to PMRpro]

Yes, I do all of the things you mention. I’m going to go back to my GP for more i/a injections too. Surgical treatment of the a/c joint doesn’t sound like fun. I just wanted an opinion from people who understand PMR. If either of you had said that I was reaching the wrong conclusions I’d have continued with the same dose of pred or even gone back to 2mg.

[PMRpro Ambassador in reply to Hughie1951]

It is difficult to know which is which - but if that is what they sound with ultrasound, you should be able to go by that. Subacromial bursitis is a PMR effect so determining which structures are inflamed is key

pubmed.ncbi.nlm.nih.gov/921...

[Hughie1951 in reply to PMRpro]

"The cause of musculoskeletal symptoms in the proximal extremities of patients who have polymyalgia rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients." Yeah, right!

If there is no evidence of bursitis on the MRI it's possible that it is just OA. But could the apparent muscular pain I've got be associated with OA or is it associated with the incompletely understood cause of PMR musculoskeletal pain?

I think I'd better ask to see the actual MRI report.

I could assume there's an element of PMR and increase my pred a bit. Which will improve my OA symptoms too! Or I can keep on reducing and if the pain gets worse I've maybe come down too low. But reducing the dose may also, even at that low level, have some effect on the OA, but possibly not so likely.

It's bit of a quandary. I'd like to get off steroids but I do wonder whether it's going to be a mix and match situation with steroids and NSAIDs.

[PMRpro Ambassador in reply to Hughie1951]

"or is it associated with the incompletely understood cause of PMR musculoskeletal pain" - probably.

Swollen ankles and hands in early PMR is often RS3PE syndrome.

If PMR is still in the mix, then you will need some pred, even 1/2mg can be enough. ANd believe us - it can last a long time! Longer than many doctors will admit.

[Hughie1951 in reply to PMRpro]

RS3PE, that’s something new to add to my knowledge database.

[Hughie1951 in reply to PMRpro]

Looking at some of the other papers associated with your link might explain the swelling of my ankles in the early stages. That symptom usually just elicited a shrug of the shoulders!

[Nightingales in reply to Hughie1951]

hi Hughie, just a point to consider. I found that the injections under US or X-ray guidance much more effective than the GP office. Eventually I had very successful shoulder and tendon surgery . Looking back it was different to PMR which I still have along with aching shoulders.

[Hughie1951]

Can I ask what surgery you had? The shoulder pain I get now is totally different to the way it manifested when I first had PMR.