Have had PMR 3 years. Had 2 flares-now 3.Each time I try to go below 9mg Pred. First time only right thumb, second time thumb and inside left ankle. Took 30 mg(learned from forum not to go that high) However got down to 13 in two months. Know it was fast but had no problems. This time March 4 at 10.5. Thumb and ankle pain and swelling. Upped to 12 for one week, 15 one week - some relief for thumb. 20-3 days. Same. Went to two Drs. First, foot Dr.,refused to give injection because he said that might cause damage to tendon. Wear shoe inserts and maybe I'll get an MRI. Keep calling for MRI appt. Hasn't returned call. GP had no suggestions but doesn't think it's PMR related. Go to Orthopedic Dr (couple weeks) or go up to 30mg? Does feel better by afternoon but still some swelling. Thanks so much for any suggestions.
I get the feeling that this is not entirely typical of pmr symptoms, but I do think that it involves the same mechanisms that respond to pred dosage.
Your much-localized symptoms suggest it would be useful to get more into your blood test data looking for answers, maybe for example it is more along the lines of a concurrent RA condition, which I believe would similarly respond to prednisone.
Especially if you are not having much (if any) of the typical, symmetric pain about the shoulders and hip joints, another diagnosis (and treatment) might apply.
On the other hand, I have myself had to periodically adjust my pred dosage for the worst of (at the time) different, localized, transient symptoms (including feet, thumbs, ribs, ear-ache, etc.) that periodicallyaccompanied my pmr package-deal.
Your persistent relatively-high pred-dosage requirement suggests that your rheumi might make a good case for adding another (perhaps steroid-sparing) medication to the mix, but only in review of your medical history, bloods, etc., and in consideration of how well that you are currently getting along with pred's many possible side effects.
I think I agree with your GP - it doesn't sound very PMR-ish to me.
About 1 in 6 patients with PMR get a revised diagnosis at some point. Probably the most common is late/elderly onset RA - and an inflammtory arthritis might fit with your symptoms. It is a rheumatologist you need to check that sort of thing out.