Rheumatoid Drs

Posted by bren0718 @bren0718, Mar 8 10:08am

I was diagnosed with PMR in August of 2023. My family doctor has been all I have seen about my disease. I was ok with her until I came on this support group and now realize I dont know much about the disease itself or about tapering off of the prednisone. In December I was diagnosed with severe osteoporosis. My Dr told me to start tapering off quicker . I have gone from 20 mg to 7.5 . She never told me at what rate to taper or that if I was having a hard time I could go back up for a bit and then try again. I think I need to see a specialist after seeing all your comments. I have only had blood work done the one time and don’t understand the numbers that people are posting. I feel I have done myself a disservice by not seeing a specialist. Do any of you just have your family physician treat you ?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@dadcue

I don't think they really know what PMR is. Perhaps a combination of autoinflammatory and autoimmune.
https://pubmed.ncbi.nlm.nih.gov/34798314/#:~:text=Background%20and%20aim%3A%20Polymyalgia%20rheumatica,partially%20understood%20immune%2Dmediated%20mechanisms.
My rheumatologist made a comment to me once that made me curious. I'm not sure what disorder he was referring to because I have several. We were discussing "immune system memory." His comment was, "my immune system was unlikely to forget what it has been attacking for so many years."

I googled "immune system memory and autoimmune disorders." I found the following:

"In an autoimmune response, when memory cells are formed against the “self,” they help mount a highly efficient pathogenic response against the body's own tissues. These memory cells, by virtue of being long lived also become very difficult to eliminate."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067599/#:~:text=In%20an%20autoimmune%20response%2C%20when,become%20very%20difficult%20to%20eliminate.
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PMR is supposed to "burn itself out" in a year or two which suggests more of an innate immune response. That clearly didn't happen in my case. The longer PMR persists, maybe it becomes an adaptive immune response.

I'm just glad an IL-6 inhibitor seems to stop my PMR symptoms. Unfortunately, my symptoms have returned whenever Actemra was stopped. This might explain why my rheumatologist has no plan to stop Actemra anytime soon. During our discussion about when to stop Actemra was when he made the "immune system memory" comment.

People with RA and other types of inflammatory arthritis don't ever have their biologics stopped unless the biologic stops working. That is usually when their immune systems form antibodies against the biologic.

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That’s consistent with my experience too. I had a good long stretch of over a year where my RA was well controlled, no flares, no symptoms other than hand weakness, which never improves. I asked my Rheumy whether we should think about reducing dosage or increasing intervals of Remicade and he said emphatically no. “We’ve spent three years managing symptoms and titrating dosage for one year of stability. Don’t change anything for a while”. 🙂
A month later I had a big flare and he put me on 20mg of Prednisone and tapered me down

I have had two biologics fail - Humira because I could not tolerate the dosage of methotrexate required to avoid antibodies to it, and Enbrel failed for reasons unknown.

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@bren0718 … FYI I sent you the name of a Rheumatologist in Lynchburg… may be helpful.

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@pb50

@bren0718 … FYI I sent you the name of a Rheumatologist in Lynchburg… may be helpful.

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Is it Dr Kenny? Just heard that he is retiring which leaves a lot of people scrambling to find someone new. I will most likely have to gout of the area.

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Damn he seems too young to retire!! Well he’s the only one I saw.

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@pb50

Damn he seems too young to retire!! Well he’s the only one I saw.

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He looked like a medical student in the link you posted.
https://cdn.prod-carehubs.net/n1/748e8fe697af5de8/uploads/2024/03/IMG_2344.png
Then I found this:
https://www.orthovirginia.com/providers/eric-r-kenny/
Eric R Kenney: University of North Carolina in Chapel Hill, Bachelor of Arts in Chemistry, 1981

1981 was when I graduated but I spent 4 years in the military before starting college. I'm almost 70 so I suspect he is 65 at least.

@bren0718
Maybe this one but she looks young too.
https://www.orthovirginia.com/providers/emily-l-gilbert/
Emily L Gilbert MD, PhD
Mayo Clinic, Rheumatology Fellowship, 2022
Mayo Clinic, Internal Medicine Residency, 2020

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@dadcue

He looked like a medical student in the link you posted.
https://cdn.prod-carehubs.net/n1/748e8fe697af5de8/uploads/2024/03/IMG_2344.png
Then I found this:
https://www.orthovirginia.com/providers/eric-r-kenny/
Eric R Kenney: University of North Carolina in Chapel Hill, Bachelor of Arts in Chemistry, 1981

1981 was when I graduated but I spent 4 years in the military before starting college. I'm almost 70 so I suspect he is 65 at least.

@bren0718
Maybe this one but she looks young too.
https://www.orthovirginia.com/providers/emily-l-gilbert/
Emily L Gilbert MD, PhD
Mayo Clinic, Rheumatology Fellowship, 2022
Mayo Clinic, Internal Medicine Residency, 2020

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I was in the marine Corps! Vietnam era.

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@dadcue

He looked like a medical student in the link you posted.
https://cdn.prod-carehubs.net/n1/748e8fe697af5de8/uploads/2024/03/IMG_2344.png
Then I found this:
https://www.orthovirginia.com/providers/eric-r-kenny/
Eric R Kenney: University of North Carolina in Chapel Hill, Bachelor of Arts in Chemistry, 1981

1981 was when I graduated but I spent 4 years in the military before starting college. I'm almost 70 so I suspect he is 65 at least.

@bren0718
Maybe this one but she looks young too.
https://www.orthovirginia.com/providers/emily-l-gilbert/
Emily L Gilbert MD, PhD
Mayo Clinic, Rheumatology Fellowship, 2022
Mayo Clinic, Internal Medicine Residency, 2020

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Wonder what her PhD is in? My Rheumy has a PharmD in addition to his MD. I think for auto immune illness that’s a great combo.

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It’s University of Mississippi, Doctorate in Physiology and Biophysics, 2016..
That’s a value add too.

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@bren0718

Yes. But having a hard time so I think I’m going to go back up to 8.5 for a few days to see if it helps. I lift weights and do yoga 3/4 days a week. Trying to stay active. I need get off of prednisone because I have severe osteoporosis.

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It seems like the chorus has all chimed in about the importance of a rheumatologist. I really hope you’re able to find someone. I know it’s usually a long wait, but they’re so much better positioned to help with the how it all fits together. Maybe you can see them once and after that if you need follow-up, you can do telehealth?

It can be dangerous or at least risky treating PMR without a specialist because of the symptoms, side effects to prednisone, etc.

It’s pretty common for people with PMR to need to supplement calcium and vitamin D, and/or start a medication preventatively for bone loss. My dad didn’t have osteoporosis, but because of his age, his rheumatologist started him on Fosomax as others have mentioned.

It may be worth asking your primary about that too if you’re not already covered by your treatment for osteoporosis.

Wishing you all the best.

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