Hand inflamation following PMR

[Kiyomasa]

Hi there, I suffered bad PMR for nearly three years, strating on 30mg of pred. Tapering down until about six weeks ago... maybe too fast towards the end, the GP put me on Naproxin. Aches and pains were fairly bad but a trigger finger has led to inflammation and paralysis to both hands. No one seems to have an answer. The rest of the PMR is under control but the pain in the hands due to the edema is unbearable... I cannot tie a shoe lace or undo a jar for example. The inflammation marker (CRT?) is 27 from a recent blood test but the symmetry is what baffles the GP. Could it be adrenal fatigue? Edema from Amlodopine, (surpressed by steroids and only now showing up), arthritis? Any ideas. The forum has been a great deal of help over the last two years, thank you. I am somewhat desperate.

[SheffieldJane]

Personally I would be trying a process of elimination such as trying an alternative blood pressure med. Does extra Pred have any impact on the dreadful situation with your hands? It is behaving a bit like PMR. I would be wanting an MRI scan to see what’s going on. You have my profound sympathy.

[Kiyomasa in reply to SheffieldJane]

Thank you. I've stopped all medication as a process of elimination. I'm seeing a locum rheumatologist tomorrow... I was going to write; 'fingers crossed' -- but that's not possible. Amlodopine (for blood pressure) has edema as its primary side effect but I've noticed that in 36 hrs of not taking it that my hand is maybe 10 percent better and the pains in my legs are definitely easier. I shall ask (!) for an MRI as you suggest and repost then. I'm male, 65 and thrown completely by PMR... it has cost me my livelihood and affected marriage and every aspect of my life. The medical community do seem to see it as a dead-end illness. There's comparitively little research and one treatment -- steroids, which are very disagreeable. I have found this forum a better source of information than any official channel so thank you (all) again. I will report back!

[PMRpro Ambassador]

Ask them if they have heard of RS3PE? Really not uncommon alongside PMR and it causes bilateral oedema. Responds to moderate doses of pred. Though it is more common early days of PMR and not at the end but all sorts of things happen.

Is that CRP outside the lab's normal range? That is usually in brackets after the result.

[Kiyomasa in reply to PMRpro]

Thank you -- I shall ask as you suggest. I will repost what his terrible new symptom is and maybe it will help others.

[Kiyomasa]

But... two minutes on Google repays: 'A repeat challenge with 10 mg a day of amlodipine resulted in recurrence of his symptoms within three weeks; ultrasound and Doppler studies confirmed Achilles tendon thickening and acute tendonitis, respectively. Again, all of his symptoms resolved after discontinuing the amlodipine [13]

[PMRpro Ambassador in reply to Kiyomasa]

Horrible stuff amlodipine - although my daughter in the ED assures me it is generally a very safe and effective BP medication and can be used alongside a lot of other drugs and comorbidities without problems! But an easy enough theory to test.

[PMRpro Ambassador in reply to Kiyomasa]

PS - just noticed you have stopped ALL medication - that doesn't help really since you don't know which may have been the culprit. Stopping likely contenders is more sensible - in this case, the amlodipine.

[Kiyomasa in reply to PMRpro]

Thanks... in order to restart selectively. The excellent rheumatologist was certain PMR had developed into rheumatoid arthiritis. A bad diagnosis for me... I'm an artist. Feeling end of the world right now. First up in the morning and I leave a trail of destruction behind me trying to make coffee. So, start back up 5mg pred, I've had x-rays and blood tests to confirm, if correct -- mathotrexate... for life. No movement in either hand for the first five hours of the day, then excruciating pain. Sincerely hope no one here experiences the same. Thank you again for this excellent board.

[PMRpro Ambassador in reply to Kiyomasa]

I wish they wouldn't put it like that - PMR doesn't magically "turn into RA". What CAN happen is that LORA (late or elderly onset RA) can present looking exactly like PMR and there are absolutely no distinguishing features to know which it may be until much later the joint erosion that is characteristic of RA can be identified with imaging.

However - RA is not the dread diagnosis it was previously, methotrexate, the first line approach, is a DMARD, a Disease Modifying AntiRheumatic Drug, which works a lot better in inflammatory arthritis than it does in PMR. It prevents or at least slows the joint damage that was the cause of disability in the past but, unlike pred for PMR, there is a wide choice of medications for RA and if you fail MTX, they will move on to something else. Pred is still used for flares and for the first few months until the MTX starts to work, but isn't relied on permanently. Most people I know with RA have very few problems.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

I have a friend who has RA - I directed him to GP originally as thought it might be PMR - and he still goes fly fishing - all over the world so his hands are fine. Hope they will be for Kiyomasa as well..