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PMR or Polymyositis depending on tapering reaction
I am tapering down to 15mg of Pred and the Dr said that when I go to 12.5mg of Pred you will know if you have PMR or Polymyositis. The reason is Polymyositis or Myositis doesn't reaction to Pred in low doses and the Myositis does not go away as PMR does so the Dr, would use a different medication at that time to relieve the symptoms. Does that make sense to anyone?
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He is saying that Polymyositis is initially treated with higher doses of prednisone. Polymyositis causes actual muscle damage that isn't prevented with lower doses of prednisone. I doubt the muscle damage is prevented with higher doses of prednisone but higher doses of prednisone alleviates the symptoms.
Doctors never want patients on long term prednisone because of the side effects. There are other treatments available instead of long term prednisone for polymyositis. Additional tests might confirm polymyositis. It is good that your doctor is considering an alternative diagnosis along with alternatives to Prednisone.
https://www.mayoclinic.org/diseases-conditions/polymyositis/diagnosis-treatment/drc-20353212
It is generally believed that PMR will go away in a relatively short period of time. Supposedly long term prednisone is okay because PMR doesn't cause significant damage to muscles and/or bones and goes away eventually.
Polymyositis does damage and doesn't go away and is probably a more serious condition compared to PMR.
I was never diagnosed with polymyositis. However my CK level was chronically elevated. Statin-induced myopathy or corticosteroid-induced myopathy or a combination of both was likely the cause.
https://www.healthline.com/health/what-is-statin-induced-myopathy-or-muscle-pain
or
https://emedicine.medscape.com/article/313842-overview#:~:text=Steroid%20myopathy%20is%20usually%20an,studied%20it%20systemically%20in%201959.
Many conditions mimic PMR and vice versa. Many conditions respond to Prednisone. PMR symptoms aren't unique so further investigation is always warranted.
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5 ReactionsThank you for the thorough explanation. I will study the links. 4.5 months of PMR experience. Thank you again,
Your post was extremely valuable to me, especially because of the links provided. Thanks for your work !
I am curious what medication
The usual ones that suppress the immune system.
https://www.myositis.org/about-myositis/treatment-disease-management/medications/
Several biologics are also being used.
https://www.myositis.org/about-myositis/treatment-disease-management/medications/biologic-agents/
I just noticed Actemra (tocilizumab) made the list. Maybe that is why my creatine kinase (CK) level is normal now. I was told that getting off Prednisone and stopping atorvastatin was helping to decrease my CK level.
I am not versed on myositis. The rheumatologist I see though is affiliated with a university medical center and he is the director of the myositis center. It's so difficult getting rhem appts, he's an excellent Dr, I am lucky.