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Diagnosed as inflammatory arthritis in knees. On prednisone. Pain in ear and headache. Worrisome

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General & Family Physician
Practicing since : 1978
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I'm 70 years old, male, and was diagnosed via knee aspiration with "inflamatory arthritis two years ago. My rheumatologist thinks it is rheumatoid Arhtritis ,but says it also could be polymalgia rheumatica. I have bee taking approx 10 mg of prednisone, for 2 1/2 years, methotrexate 15 mg/day, along with a few other meds. For the past few days I have had some intermitant pain behind my left ear and some sharp headache pain intermittantly in my temple and scalp above the temple. It comes and goes. I can still feel my pulse in the temple region but am concerned with possoble temporal arthritis and its consequences. I have an appointment with him Aug 6, I believe. Is it OK to wait?

I need to pick up my grandaughter now and will return in approx 1 to 1 1/2 hrs and will continue then.
Posted Wed, 25 Jul 2012 in Arthritis
Answered by Dr. Pavan Kumar Gupta 1 hour later
Hello and thanks for the the query.
The most difficult disease to distinguish from PMR is RA. Patients with onset of RA after 60 years of age, when compared with those with earlier-onset disease, are more likely to have PMR-like features. The similarity between PMR and RA is even more striking in those with seronegative RA.
In studies: 19% to 15% of patients with PMR XXXXXXX the American Rheumatism Association criteria for RA sometime during the course of their disease.
Dispite general agreement on the clinical features of PMR, there is no standard test or universally accepted criteria for makingthe diagnosis.

Temporal arteritis is closely associated with a disease called polymyalgia rheumatica, which many experts believe is a different manifestation of the same underlying disorder. More than 40% of people with temporal arteritis also have the symptoms of polymyalgia rheumatica. Fortunately, the same treatment is effective for both conditions.
If temporal arteritis is confirmed in you,then it can be said that probably you had polymyalgia rheumatica and not rhematoid arthritis.
Exams and Tests
The doctor will examine your head. Touching the head may show that the scalp is sensitive and has a tender, thick artery on one side. The affected artery may have a weak pulse or no pulse.

Blood tests may include:

Hemoglobin or hematocrit
Liver function tests
Sedimentation rate and C-reactive protein
Blood tests cannot diagnose this condition. A biopsy and examination of tissue from the affected artery confirm the diagnosis in most cases. The biopsy is done on an outpatient basis while you are under local anesthesia.

You may also have other tests, including:

Duplex ultrasound
PET scan
The goal of treatment is to reduce tissue damage that may occur due to lack of blood flow.

Your doctor will likely prescribe corticosteroids taken by mouth. 

Most people begin to feel better within a few days after starting treatment. However, you need to take medications for 1 - 2 years. The dose of corticosteroids is slowly reduced.

Taking corticosteroid medications for this long can make bones thinner and increase the chance of a fracture. As a result, the following should be started right away:

Avoid smoking and excess alcohol intake
Take extra calcium and vitamin D (based on your health care provider's advice)
Start walking or other doing weight-bearing exercises
Monitor the bones using a bone mineral density (BMD) test or DEXA scan

I hope I have told you in detail however you may revert to e for any further query.
Best of luck
Above answer was peer-reviewed by
Follow-up: Diagnosed as inflammatory arthritis in knees. On prednisone. Pain in ear and headache. Worrisome 17 hours later
Thank you very much for such an in-depth answer. I am very satisfied with your response. Like lots of things in life, there seem to be many shades of grey.
Answered by Dr. Pavan Kumar Gupta 11 hours later
Best of luck to you.
You can always depend upon our forum for any query.
Above answer was peer-reviewed by
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