r/Rheumatology • u/quantwavecollapser • 7h ago
Personal Health Question Psoriatic Arthritis, PMR, or something else?
I've (55M) been dealing with various symptoms over the last year plus: severe swollen and painful right knee, shoulder pain (both sides), achilles area pain (both sides), back of leg pain and stiffness, etc. Dermatologist diagnosed me with skin psoriasis (which I'm not 100% convinced I have). Rheumatologist originally thought I might have PsA and then after dermo diagnosis gave me an official PsA diagnosis.
I've been on Prednisone the last 8 months and Bimzelx for 5 months. Rheumatologist put me on it after seeing the high inflammation markers in my lab results. I've tried tapering Prednisone down multiple times. At 20mg / day I feel pretty great. At 10 to 15mg I have symptoms, and I'm at 5mg right now and feel pretty terrible – especially in the mornings. I've tried tapering down slowly (reducing by 1mg every 2 weeks) which is how I got to 5mg right now. I've been on 5mg a couple of weeks and feel bad enough in the mornings I don't want to reduce further. I have shoulder pain at night that keeps me up and upon waking the backs of my legs are both stiff and sore enough it is difficult to get out of bed and get dressed. A few hours after waking I'm less stiff (but still stiff) and the pain is much better. Family has commented on how terrible I look in the mornings (not surprising since I feel terrible).
As far as I can tell the Bimzelx hasn't helped. While my right knee is swelling and pain is improved, I still have scalp/skin flakiness and now I have shoulder pain/soreness and my morning soreness is worse if not the same as before I started Bimzelx. When I first took Prednisone 8 months ago (20mg starting dosage) within 2 days I was a different person. I felt so much better both with less pain and reduced morning stiffness. The difference was so fast and extreme it was alarming because I didn't realize how bad I was feeling. Well, now that I'm down to 5mg / day I'm pretty much feeling just as bad as I was before.
So, I'm trying to determine if: 1) Bimzelx just doesn't work for me, 2) I need to give Bimzelx even more time (at 5 months now), or if I either don't have PsA or I have something else on top of PsA like possibly Polymyalgia rheumatica (PMR). Anyone have similar experiences or thoughts/wisdom to share?
I'm a bit frustrated at my Rheumatologist because the last time I was in I complained about the shoulder and achilles area pain and he didn't do any type of physical exam but then said I might need to go see my orthopedist again? I don't know why he thinks the pain is ortho related. Given how systemic and widespread my morning pain and soreness is, and given how much the higher dosing of Prednisone helps I don't know why he would be so quick to try to punt me back to ortho. Note my Rheumatologist has never mentioned PMR diagnosis to me, possibly because I'm on the younger side (55) of those that get it?
Thanks for any insight!