OSTEOARTHRITIS OR PMR PAIN???

[SVLady]

I started on 15mg prednisone 6/15/2024 after severe shoulder, arm and hand pain plus minimal piraformis and hip girdle pain as well. Pain free within a few days. Never had abnormal blood markers so had a PET scan that showed inflammation so diagnosis of PMR. We recently took a 10 day trip to New England which included a 6 hour flight each way and lots of windshield time sitting with little walking or movement. I was totally pain free on 12.5 mg Pred the whole trip. Returned home and restarted walking the dog, doing house chores and gardening and now get hip girdle pain which sometimes goes down into my upper thighs following these activities. My rheumatologist believes this pain with movement is osteoarthritis (I am 80 but did not have this pain prior to PMR) rather than PMR pain which he says is better with movement. My dilemma is how do I know if I am having PMR flares with tapering or just having OA and can take Tylenol Arthritis tablets to control it (they do help) and keep on lowering the doses of Prednisone just coping with the pain? It seems that PMR can set off arthritis pain so I fear this may be what is happening. Any insight would be greatly appreciated.

[piglette]

If the Tylenol is working some of the pain may be arthritis, but if you are reducing the Pred. you may also have PMR pain as you have reduced too much.

[PMRpro Ambassador]

The pain that Tylenol deals with is almost certainly NOT PMR. It might be OA or it might be something else - but what matters is that it is dealt with. It is a question of achieving the ideal balance for pain relief - the lowest dose you can manage of both, because too much Tylenol isn't that good for you either!!

[DorsetLady PMRGCAuk volunteer]

Not sure Rheumy is correct in his thoughts on PMR versus OA and pain.

The pain and stiffness from both can be worse when resting or after rest [particularly in morning] and then improve with activity. The difference seems to be that with PMR they may improve as the day goes on, whereas with OA they may be worse at the end of the day.

If Tylenol helps significantly then unlikely to be PMR.

Have you decreased your Pred since you’ve been home? Whether you have or haven’t, the fact that you have increased your activity may suggest it is the beginning of a flare.

Also not sure “thar PMR can set off arthritis pain”… PMR is related to muscles, OA is in the joints… although PMR may affect the muscle surrounding the joints which may make them feel weaker.

Have you had x-rays to know you have OA?

[SVLady in reply to DorsetLady]

I have had xrays of my shoulders and they did show OA but I am not having pain there since beginning prednisone. I had a PET scan from shoulders to upper thighs and it showed inflammation in the typical areas of PMR but no mention of OA in the report. I am sure I do have OA in the hips at my age though. Thanks for your response.

[DorsetLady PMRGCAuk volunteer in reply to SVLady]

Higher doses of Pred will mask the pain of OA - many of us have been or are there. Plus as you say you may have OA in knees -but it isn’t always painful with or without Pred .

[Pixix]

I was told that higher levels of pred had helped my arthritis…but over the years it was getting a lot worse, which is normal. So, at lower doses my osteoarthritis became suddenly more painful & obvious. But it is nothing to do with PMR in my case. Just the pred masking the osteoarthritis. Lots of posts about it atm. Mine has worsened badly as the temperature drops, & I think it’s like that for most people! I don’t believe, personally, that PMR can set off arthritis pain. Tapering could appear to, but millions of people suffering osteoarthritis without PMR, & all finding it worse as the winter beckons, I think!