My Rheumatoid Arthritis has been well managed since diagnosis a few years ago with slow onset, mainly in my hands and fingers. I am on methotrexate 2.5 mg. once a week and hydroxychlor (Plaquenil) 200 mg. X 2 daily. Recent SED rate was low (25, down from 28), but 10 -11 weeks ago I begain complaining of symptoms that suggested to me that my RA was advancing, including typical PMA shoulder, hip pains, fatigue, and what I presumed was mostly job stress related depression. The rhuematology clinician that I saw then gave me a 6-day prescription for predinasone which significantly improved these symptoms. However, as I also have IBS, and had gone off regular laxatives (Linzess), I contracted a painful constipation episode. About 3 or 4 weeks ago, the symptoms of neck, hip, shoulder, sleepless painful nights, etc. returned and caused me to complain during my regular appointment with rheumatology Dr. I was diagnosed with PMA and started taking low grade predinazone (Rayos 2 mg. x 1) last night, which, with regular stool softeners, I hope will help. However, I also started having shooting intermittent pain behind my right eye about 2 weeks ago and thought it was a sinus condition at the back door, since I am outdoors in my garden much of my free time and thought pollens and molds in the dirt were triggers. Since having my eyes checked back in February, the opthalmologist suggested that the constant blurry spot in the inside corner of my right eye that seemed to be a recurrent floater needs to be monitored in my next appointment, as the previous year's tests that they give to look for visual abnormalities ( monitoring for RA drug interaction) suggested I might have a slight blind spot in that area. The temporal headache I am having is sporadic and shooting pain with some minor headaches accompanying it. I mentioned this yesterday and she suggested that I could also have the beginnings of GCA with the PMA. Having just lost two friends to brain tumors, I am fearful and want to stay on top of this. I will take the samples of Rayos that she provided me with for another week or so, and if the temporal pain subsides, then we know the medicine is taking care of it. I hope not to have to increase the level of predinasolone, but whatever works will work.
What I am curious to know is...what is the connection to my RA diagnosis or is it just a concurrent accident? Interestingly, due to my profession as a historian and being keenly interested in my ancestry, my family DNA haplogroup gives us a good inkling that our English ancestry goes back to prehistoric origins in Southern Norway. I just read about the studies linking Scandinavian heredity to increased incidence of PMA.
Thank you for any comments...
PMR/GCA is, like RA, an autoimmune disorder. When you have one autoimmune disorder, you are at a higher than normal risk of developing a second and it is possible to demonstrate the symptoms of more than one at a time.
I'm slightly confused by your comment about 2mg Rayos and requiring stool softeners - pred doesn't normally cause constipation. And 2mg of Rayos is unlikely to achieve anything with PMR - the normal starting dose for PMR is 15mg and even with concommitant MTX and Plaquenil I think it is unlikely 2mg will achieve much - they may in some patients allow a lower dose of pred to have an enhanced effect. If you have GCA that is presenting as PMR you will need far higher doses of pred. 40mg and upwards being the norm to avoid onset of visual loss. PMR is one of the listed presenting symptoms for GCA.
Interestingly, I have had a "floater" causing a blurry area in my vision pretty much since my PMR started over 10 years ago. The optician photographed it - it does move but the "oily smudge" in my left visual field is there a lot of the time. It did improve when I was at higher doses of pred, 10-15mg, but is there now I have been able to reduce to 5mg though less than it was at the outset. However, neither my optician in the UK then and my eye specialist here in Italy now can see anything that suggests any damage to the optic nerve due to GCA. My peripheral vision test is 100%. The general consensus is that I have GCA affecting the arteries in the thorax - I had had a few weeks of the "typical" scalp pain which resolved spontaneously and jaw claudication that also resolved after some time on 15mg pred and which has not returned.
The temporal pain COULD be something else - and as I say, if you are really only on 2mg of Rayos then it is not going to resolve GCA symptoms.
I shall be interested to hear the rest of the story.
Thank you for your input here. Interesting too that you had the floater in your visual field.
I thought I understood that PMR was an inflamation and not technically an autoimmune condition itself. I may be wrong by saying that, and would be interested to know other information.
When I was tried on a higher dose of preds a couple of months back, because of my susceptibility to bowel reactions, I did have an obstructive problem and found an article on the web that pointed it out a possible (but not common) side effect of predinasone. Since my IBS is sensitive to a lot of common meds and supplements such as calcium and mineral supplements and some decongestant meds, I guess I should just expect the possibility of reaction with any new additions.
Yes, the clinic wanted to start me out on a low dosage pred to start with. My impression was that I was given the samples to start with for the PMR symptoms and that, if the headache symptoms are affected by the low dose within a few days, then we know for sure it is GCA in addition to the PMR. Otherwise, I am to go for biopsy and perhaps other diagnostics to rule out the other. Increasing the dosage would be the next step, depending on my PMR symptoms being relieved or not.
What we call PMR is the symptoms of an underlying autoimmune disorder which causes the immune system not to recognise our body as "self" and so attacks the body tissues. This leads to damage and inflammation - which are the cause of the pain and stiffness. I skipped that step of the explanation, sorry.
Whatever the reasoning there is no point at all starting a patient with query GCA on 2mg of pred. It will do nothing and is unlikely to affect GCA symptoms at all for good or ill so it is not a test of "Is this GCA?". I haven't come across anyone for whom 2mg would have made any difference to PMR either. I'm just saying it isn't a valid test.
Ooops - forgot - biopsy is only positive in about 40% of cases and so is also not an entirely valid test. What it DOES do is confirm GCA without any question if it IS positive and no-one will ever argue with the diagnosis in the future. But a negative test does not necessarily mean you don't have GCA - the symptoms remain king. That of course may mean you are treated for GCA "just in case" if the symptomatic evidence is highly suspicious - but the alternative may be losing your sight without treatment.
Because the presenting complaints I had at my appointment on Monday were diagnosed as PMR definite, I only "threw in" the complaint of the temporal pain since it has only been coming sporadically and for a bout two weeks, causing me to suspect it was possibly a sinus headache hiding in the background. As a sinusitus would have "matured" into a decongestant treatable condition by now, the clinician suggested giving it 2 or 3 days to see if it cleared up as an allergy reaction or it it resolved with the treatment she gave me for the PMA. I think that I should definitely call the office before Friday for further evaluation. Thanks for all your input.