Hi everyone I was diagnosed with early osteoarthritis in my neck and spine, also knees, by a rheumatologist approx. two years ago. No special meds just otc pain killers. I tried physio but felt worse after it, light headed. I have had neck aches, headaches, lightheadedness on and off since, good and bad days. About five weeks ago I had the flu and pneumonia jabs in my left arm. My arm was sore for several days and I didn't feel well for a couple of weeks. For a few days now my right shoulder has been stiff and painful also the top my right arm and my neck. I also have aches in my lower back but I have had this before over the years. Is there any way of distinguishing PMR from osteoarthritis? I'm stiff in the mornings but loosen up after a while but my neck ache is usually there and now too my shoulder aches and pains. I have lost over a stone in weight this past year but my appetite isn't what it was before my diagnosis. Bloods done in June were normal, no rheumatoid arthritis. Your thoughts would be appreciated. Thank you
EILEEN IS OUR RESIDENT PMR ADVISOR ..I'M SURE THIS GOOD LADY WILL HELP YOU
your symptoms do sound like PMR
Hi Jayn36190
The pain in your shoulder and neck could be shoulder bursitis but you will need an ultrasound scan of your shoulder to confirm a swollen bursa in your shoulder......
When the diagnosis of OA was made - HOW was it made? Did you have imaging done that showed damage in the joints? Or was it like both mentions of OA for me from supposed professionals? "you have OA in your knee, I can feel it" said a rheumatologist and, some years later, "the low back pain is due to wear and tear (early OA by any other name) and you will have to live with it" from an orthopaedic doctor. A full 13 years later the knee shows NO sign of any OA on an x-ray and the low back pain was eventually ascribed to a total meltdown of my back muscles which were so spasmed they were as hard as floor boards! Mobilisation of the muscles etc has resulted in near freedom from pain for the last 4 years. Ergo - neither diagnosis was correct.
What you describe could well fit with PMR and the fact that blood levels are "unremarkable" means nothing, neither for PMR nor RA which can also exist as a sero-negative form. One in 5 PMR patients have blood markers ESR and CRP that are "within normal range" - but that doesn't mean they aren't raised for YOU. My ESR hovered at 16-18 for some time so were ignored - my own personal normal is low single figures. The weight loss is quite typical in PMR/GCA for many people and is mentioned in the list of signs and symptoms. It alone demands investigation - PMR is not the disease, it is the name given to a set of symptoms that is caused by an underlying disorder. In our case an autoimmune problem but there are several others, some of which would typically cause weight loss.
Thank you all for your replies.
My OA in neck and spine was diagnosed from xrays. Ths rheumatologist gave me a physical examination and my knees were making clicking and grinding noises (so does my neck). She commented that my neck was in better condition than hers after she suffered from whiplash. The physiotherapist said I had tense muscles in my back but never did anything about that, just gave me exercises for my neck.
When I first went to my doctor with my neck pain I mentioned PMR to him but he dismissed it. It came out of nowhere, held my head back in the shower and felt a pain shooting down from the back of my neck. I thought it was from the dog pulling on his leash (my friends dog I used to walk regularly). My CRP was slightly elevated back then but I suppose that could be due to arthritis. My ESR has always been slightly raised for as long as I can remember so I think that is normal for me, at least that's what a doctor told me 30 years ago. I had a full blood check in June and all was normal.
I also went to ENT about a year ago for my lightheadedness and tinnitus, he did the epley manouvre and I had hearing tests, all normal. He said most likely to be caused by nerve pressure in the neck from my arthritis.
I get health anxiety for which I am taking citalopram 10mgs and bendroflumethiazide 2.5mgs for border line blood pressure.
Before retiring I was Ok, this has happened since finishing work and taking up dog walking twice a day for two years. I've never smoked not do I drink alcohol.
I will probably go see my doctor again for reassurance.
Thanks everyone, hope you all have a peaceful Christmas.😊
My knees and neck also make clicking and grinding noises - it isn't due to OA! They use that as a get out.
If a physio said you had tense muscles in your back there was not a lot of point offering you exercises until they had sorted out the muscles - it could well be due to myofascial pain syndrome, something often found alongisde PMR and caused by the same inflammatory substances that caue PMR when they are systemic - in MPS they are located in the muscle fascia (the transparent skin you will know from joints of meat and poultry) or in the knots of hardened muscle fibres that can be felt in larger muscles, usually in pairs on either side of the spine, in the shoulders, about rib level and in the lower back, about where the baby's dimples are. Dog walking is likely to make that more uncomfortable, especially if the dogs pull on their leads.
Wow Eileen, you really know your stuff. I am going to have to read it again and try to understand it all, it warrants more than just a quick response. Thank you so much for taking the time to reply. I have shopping to do today so I'll read it again later and try to take it all in.😊
Eileen has given you all the relevant information and I do hope you can persuade your GP or whoever to let you try Prednisolone. Like you I was first diagnosed as having OA but, in fact, I had both and it was the unusual weight loss that the clincher for the PMR diagnosis although I suppose I was lucky ( ? ) that my ESR and CRP were both high which was another box ticked . OTC painkillers do nothing for my OA but while I was on Pred. I had almost no pain from either condition.
The PMR has been in remission for more than five years but the OA pain comes and goes. How to tell them apart? Difficult. I think the main difference is that I know that once I can persuade myself to get out of bed, have a hot shower and start the day's chores ( garden, greenhouse, housework ) the pain will ease. This was definitely not the case with PMR before the steroids kicked in. Also, although the OA pain is a drag it was the unutterable weariness and low mood that went with the PMR that differentiated it.
That's just my experience; there are many individual differences. Many people have found this forum a godsend; I hope we can help you, too.
Hi Betty Thank you for your informative and helpful response. When I thought I had PMR and asked the doctor about it, I asked if I could try steroids but he refused point blank. He said if he gave everyone steroids he'd have no patients as steroids would cure just about everything. He is a well respected doctor at our surgery. Another response that requires more reading. Thank you so much...
Well respected he may be but he's talking rubbish! It will deal with pred-responsive inflammatory diseases - but there are a lot that aren't, fibromyalgia for example, but which can appear very similar. And PMR is characterised by often responding very well to 15mg pred - very little else does.
I was diagnosed both through clinical presentation and x-ray with osteoarthritis at age 40. I'm sure I already had some manifestation of it earlier. It wasn't until I was in my mid-sixties that PMR came along. For a long time I assumed it was the OA getting worse (which hadn't really bothered me before, I was careful and did my exercises faithfully and needed no medication). But after a year or more I finally met a doctor who tried the pred trial (as well as taking a number of relevant tests). I had a magic response, within three days I had no pains - not even the OA, which was nice for the first couple of months until my pred dose gradually tapered, but PMR pain is different and is still well controlled by a very low dose of pred.
Hi Jayne - 'careful what you wish for' springs to mind from my experience - but like you my symptoms were Atypical of PMR despite have quite raised inflammatory markers and tbh I had my doubts if that was my diagnosis, - especially reading how some people suffer with it on this forum. I so wished I had researched Steroids (Pred) and found this site before staring on a full course - especially as I didn't know I would be on them for years....I thought just until the inflammation had subsided. Nor did I know I would have to wean myself off the Pred! I was not properly informed before I started. As your GP said steroids will help almost any inflammation / problem and he'd have no patients.....my prescription came from a rheumatologist - going by the book! I had every side effect possible and more.....I have breathing problems, full on heart palpitations (doc now want me to take Beta Blockers), weak leg muscles, the start of cataracts and a massive weight increase........in fact Uncle Tom Cobley and all..... I am weaning myself off Pred by 1mg a week and don't want to speak too soon but am now down to 6 mg on Monday....I am very tired, exhausted in fact but have very little pain - which I can take some Co-Codamol for when it occurs and it works for me...... I refused Beta Blockers for the time being to see if reducing the steroids helps and it has, they are currently no where near as full on as when I had the heart monitor fitted for a day last month.......of course all these things could have been coincidental but I am sure it's the Pred! So, I wish you well but if you are unsure yourself then please try for a 2nd opinion and do a little more research...try to get some massage to see if it helps with your neck pain along with some anti-inflammatory OTC meds etc. AND get that dog under control....lol.....x I hope you get some more answers before starting on the steroids and there is plenty on this forum but many contributors obviously suffer from PMR so badly I understand why Pred is their friend but it has def been my enemy and I'll be pleased to see the back of it - having said all that not everyone gets so many side effects and if you chose to take it then I sincerely hope you have a smooth ride but I would look for other meds that may help your osteoarthritis for the time being and maybe get a Bone Density scan - my BDS was within normal band and no osteoarthritis but was still told that 3 wedge fractures of the spine were caused by osteoarthritis - couldn't make it up could you. Here's to a good 2019 for everyone....KR xxx
The usual description of PMR is bilateral muscle pain in your shoulders and/or hips. It tends only to be helped by steroids. Have you tried other painkillers? Did they work? Did they pretty well suppress the pain? Do you have trouble lifting your arms? I had trouble even lifting a spoon or fork to eat.
Hi jayn36190
I agree with missmagwu if you can manage without preds...do!..prednisolone will manage the PMR pain and that's great but then you have to contend with all preds side effects and there are many i had 15 of them, i found out on this forum there are 80+. I knew nothing about steroids and doctors do not volunteer information you find out for yourself when it's to late to abruptly stop them. I eventually tapered off them that was 2 yrs ago and i am fine now. I have OA and post herpatic neuralgia left from shingles caused by the preds. So in a nutshell don't be in a hurry to take preds.....happy holibobs one and all..
I'm overwhelmed by all the responses, thank you everyone😊.
Oh Eileen, I wish I had a friend like you to take along to my surgery with me, you tell it like it is
😄. All you say re the MPS makes such good sense as from what I've read it can be caused by poor posture. My posture is quite bad really due to sitting at a computer all day, even my rheumi said it was the likely cause of my neck OA (forward head posture) and probably triggered off by the dog pulling on his leash.
Sounds like you have had a run around with your doctors over the years fobbing you off with OA all this time, quite unbelievable really.
So my clicking knees may not be OA after all. I think I will see a different doctor next time for a second opinion.
The other symptoms I forgot to mention are restless legs whilst in bed and itchiness. Drives me mad sometimes. I always feel like resting after I've been out like today for instance, I had to go shopping, my shoulder was very painful, feels a bit hot to touch too. I'm now having a rest because I always feel tired when I come home and I always feel better after a short rest. I seem to have to pace myself these days and a few years ago I was rushing around everywhere, coming home from work, housework, cooking, going to my mother's house doing the same for her, taking her shopping, helping my daughter out with cleaning, now I'm limited to what I can do. So frustrating.
Thanks for your help, wishing you well😊.
Thanks Mary My shoulder is a bit hot to touch but I don't think there's any swelling there. I'll see how it goes over Christmas and will probably go back to the surgery if it persists. Hopefully it will disappear as quickly as if came. Best wishes to you😊
Having had to manage without pred for 5 years - I totally disagree with you I fear. It isn't a simple case of pred bad, no pred good. As long as there is unmanaged inflammation coursing through your body it is causing damage and potentially setting you up for extensive peripheral vascular disease later or even certain cancers, amongst other things. Used properly and carefully they are a valuable approach - and when you know how, most of the side effects are manageable to a great extent,
Hi Betty Yes thank you, Eileen sounds great, really knows her stuff. So sorry that you have both conditions and that was what I was wondering, how can you tell them apart. So it seems that PMR is more persistent than OA with regard to being in constant pain. My aches are all over my body in the morning's but generally ease off once I start moving. They do come back again though once I stop. I do get tired easily but I'm not sleeping well lately either. I cannot get comfortable in bed and feel fidgety a lot. I didn't get off to sleep until 5am this morning. Thank you so much for taking the time to reply, I agree, this forum is wonderful. I hope your PMR stays in remission. Take care.😊
Hi Eileen H
Jayn bloods are normal it would be a different scenario of her inflammation markers were high. The point i was making is.... if it's not broke don't fix it...
Hi Jayn36190 If you have a swollen shoulder bursa you cannot feel it because it is located amongst your muscles and ligaments. If the pain continues request an ultrasound scan of the painful shoulder. I hope is resolves and the pain goes away...if not get it tested.....👍😊...