Rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR) are inflammatory rheumatic diseases, each with its own characteristic features and typical presentation. However, diseases do not always present similar to the way they are outlined in the textbook. This article examines the cases of two American Indian patients who had a PMR-like presentation of RA. The first patient was vastly seronegative except for 14.3.3 ETA, a dynamic biomarker with high specificity for RA. This appears to be a novel presentation, as there have not been prior documented cases of PMR-like onset of isolated 14.3.3 ETA+ RA. The second patient was noted to have an atypical PMR-like exacerbation of strongly triple seropositive RA. Intense lifestyle treatment combined with standard/conventional therapy led to a significant resolution of symptoms in both cases.