Can early PMR exacerbate pre-existing mild osteoarthritis or past joint injuries?

[Landerman]

Nine months before I was diagnosed with PMR (late Sept. '24), I began having right hip pain, which at times made it hard to walk, not to mention nearly impossible to sleep. X-rays revealed only "mild osteoarthritis" - nothing to be alarmed about or treat. I then began to have trouble with my left knee for the first time after a knee/leg injury 30 years ago - the pain was so out of control in late August it sent me to the ER. X-ray and MRI indicated slight osteopenia and meniscus tear. Again, nothing alarming and no recommended treatment. About this time, I began to notice, and feel, whole body muscle and joint aches (neck to knees), which developed into full-blown pain and immobility (yes, we all know about that...) - which finally got diagnosed as PMR.

Prednisone did its thing, and reversed the pain and immobility in a few days (wonderful!). The strange thing is that now, about two months into prednisone and tapering, my hip and knee pain are almost fully resolved too. Months of pain and discomfort have yet to come back.

Is it the prednisone itself? Or is the prednisone treating the PMR inflammation that triggered the knee and hip pain even before full body symptoms of PMR emerged? Any thoughts?

I'm new to PMR and this sight, but really appreciate the spirit of compassion and information and advice in all I have read here. Thank you everyone.

[DorsetLady PMRGCAuk volunteer]

Hi and welcome,

Many find that higher doses of Pred do mask the pain of osteoarthritis- in fact it does that with virtually all inflammation no matter the cause. But they also discover that as they reduce the dose, those OA pains return, and the disease had also deteriorated in the meantime.

As for PMR stirring up old pains, it may well do, and very often it is bubbling along for quite a while before we realise there is something amiss. Many have said they have had months of “things not being right” but hadn’t realised what it was, or just put it down to age or doing too much.

as you are new, you might like to have a look at this for some general info on your PMR -

healthunlocked.com/pmrgcauk...

[Pixix]

The higher doses helped, or as the consultant called it ‘masked’ my osteoarthritis. When I got to lower doses it was then far worse than it was before PMR started. The risk, as explained to me, is that, because it appeared better, I did lots of heavy-ish gardening, longer walks, lifting stuff, that I had been warned not to do! But, for me, it was as if my OA had improved considerably. So, just a warning on that score, &, also, mine came back very unpleasantly at lower doses, & has now(I’ve had PMR for five years) I am down to 1mg, I’m in significant acute pain. But that does not mean it will follow the same path for you! My worst area is hands, thumbs, wrists…& toes..all a bit essential for daily tasks!

[PMRpro Ambassador]

Hi and welcome!!

The pain you had was almost certainly the earliest symptoms of your PMR - mine was exactly the same, right hip and groin pain that was excruciating when I first stood up and I was quite sure it was OA in the hip - at 51!! I also had knee pain in the same leg and the first time I saw a rheumy I was informed the knee and hand pain was OA, she could "feel it". No x-ray, get on with it. I felt sorry for her patients if she treated a colleague's wife like that!! Thirteen years later an x-ray here in Italy showed no evidence of OA at all.

After 5 years of the same symptoms you describe with apparently baffled doctors, I spent a lot of time on the internet one winter and finally identified something that fitted nicely with my symptoms. I eventually saw a rheumy who wasn't enthusiastic about it being PMR - despite the dramatic response to 15mg pred in under 6 hours - he wanted it to be an inflammatory arthritis but I couldn't start the drug he wanted to use as I was about to move to Italy and hadn't got a specialist here, so I continued with pred. No-one has suggested anything else.

Anyway, after about 3 or 4 months the hand, foot, knee and hip pain had all just about gone and only the hip pain returns at intervals. It is trochanteric bursitis and is an integral part of my PMR, The rest had been synovitis, also part of PMR. There is no sign of OA of a severity that will cause the level of pain - here they don't rely on just "feeling".