Distinguishing between arthritis and PMR

[Mosquito1]

Hi

My sister was diagnosed with PMR a few years ago and prescribed steroids . These reduced the symptoms of the acute phase and she has been on them for 2 years now currently reducing and on 4mg per day ( I think ). She also has some osteo and rheumatoid arthritis. Since was put on methotrexate 6 months ago and feels no better. She is very stiff and in a lot of pain. She has seen a rheumatologist twice over the 2 years, the specialist nurses don't phone back . It is not clear to her what is causing her pain ie PMR or the arthritis and if anything more can be done about it. Also if methotrexate isn't making her feel better is it worth taking? She has asked her doctor for x rays to understand extent of her osteo arthritis and is waiting to hear.

Any one any experience or ideas please?

[DorsetLady PMRGCAuk volunteer]

MTX is used successfully for RA. In PMR the results are not necessarily as successful but it does help some people reduce the steroid more easily- but not all - and after 6 months I would say she may well fall into that category.

OA, depending on how severe it is may be helped by Flexiseq [no drugs in it] - but always worth a try -

flexiseq.com/products/

Plenty of products online to choose from, sometimes what suits one person doesn’t suit another, so it’s is bit ‘try it and see’ - topical gels can be used sparingly - but not ibuprofen or other NSAIDs in tablet form.

Hopefully the X-rays will confirm the state of her OA - which might help her decide what pain is what.

Much more advice on OA on versusarthritis- another excellent site-

versusarthritis.org

[Mosquito1 in reply to DorsetLady]

Thank you very much, I am going to try to get her to sign up to this site too!

[tangocharlie]

Did she feel better on the higher doses of steroids? If so it might be that her dose is now too low to control the inflammation? It is possible, but very unlikely that the PMR will have gone away entirely in 2 years. She really needs to see a rheumatologist. Perhaps try and get her GP to intervene or contact the Patient Liaison team at teh hospital and explain the situation. Or even the rheumatologist's secretary and ask them if they can help, they can usually get things done. I usually try and butter them up saying something like please can you help me, you're the expert, what you do if you were me?

[Mosquito1 in reply to tangocharlie]

Thank you, yes she did feel much better on the steroids but needed at least 20mg per day if not more and her skin was terrible, just like tissue paper. Her rheumatologist who she has seen twice in the 2 years told her to reduce and added in methotrexate. But she is metho injection of 25 something per day, which I think is the max and its making no difference after 6 months and still on around 3 or 4mg steroids I think

[PMRpro Ambassador]

The MTX MAY be doing something - but she still needs more pred than she is currently taking. MTX allows some people to get a couple of mg less on the pred, some it does really well for and for others it does nothing in PMR. So if she were to stop the MTX, she might find she needs more pred - or she might be fine, And it is quite possible it is the MTX that is making her feel unwell - it did me!

[Mosquito1 in reply to PMRpro]

Thank you for replying there seems to be a common theme here!

[tangocharlie in reply to PMRpro]

Perfectly explained as always Pro