Polymyalgia and Rheumatoid arthritis

[Deemar]

I was diagnosed with PMR in June 2014.

Over a period of about 7 years I managed to come off prednisone but after a time the PMR returned. Since 2022 I have managed to get down to 7mg daily and then have a flare. Back to 10 down to 8 and another flare.

I live in France and it seems PMR is not as common as in the UK and something the medical community are not as knowledgable about. I have seen, over this period, 3 rheumatologists who each in their own way has tried different treatments and dosages of prednisone. Over the last couple of years I have been managing it with the help of my GP.

We spent the month of October in the UK and whilst there I had a private consultation with a rheumatologist in Bristol. He was very thorough going through my past history and then explaining to me his thoughts.

His recommendation was

“have checked some blood tests today to look for rheumatoid factor and other antibodies that we sometimes see in this scenario. We could potentially consider x-rays and ultrasound scans of your hands and feet, but I think these would be unlikely to be helpful given that your symptoms are currently more settled on a slightly bigger dose of steroid.

My recommendation therefore, is to start methotrexate as an additional treatment. We use this quite commonly in difficult to treat polymyalgia, but it is also a standard treatment in rheumatoid arthritis. It would take two or three months to start working, so it would be necessary to continue your current dose of prednisolone for that period, with a view to weaning it down and then stopping it entirely.

The anti nuclear antibodies test was positive which I believe points to the diagnosis of RA.

I have, of course, to discuss this with my GP here and decide how to proceed. I’m very reluctant to start a new drug and wonder , at the age of 81 and in pretty good health apart from the PMR, if I seem to be stable on a dose of 10 mg which I can reduce from time to time if this is a way forward.

[PMRpro Ambassador]

rheumatology.org/patients/a...

How high are the ANA results - almost everyone has some, healthy people too.

In a second episode after 7 years and good on pred, I think at your age I would be reluctant to try MTX. But you have to try it to find out if you are someone it helps - it works well for a small cohort of patients but by no means all and has its own, often unpleasant, side effects. In your case it is also going to mean find a rheumy who accepts the UK advice as MTX can only be used by specialists.

[Deemar in reply to PMRpro]

1:1280 homogenous pattern.

[PMRpro Ambassador in reply to Deemar]

Hmm - then I would agree that it is very unlikely to be PMR, there are no identified antibodies as yet and ANA is not positive in PMR. But it may not be RA - I think you need a thorough discussion with your rheumy in France.

[Deemar in reply to PMRpro]

Thank you for your replies. I do wonder about just sitting back and seeing how I go over the winter.

[PMRpro Ambassador in reply to Deemar]

Fair enough - but the likelihood this isn't PMR and there may be a far better option for managing it. If it were to turn out to be RA, there is the risk of erosion to the joints which DMARDs like methotrexate prevent.

[Deemar in reply to PMRpro]

But I have no joint pain, all the pain I have had is muscular.

[PMRpro Ambassador in reply to Deemar]

Which is why I say - may not be the RA the UK rheumy is so keen on. But with an ANA like that, it is something so you need a discussion with a rheumy