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PMR with normal blood markers

Polymyalgia Rheumatica (PMR) | Last Active: Aug 14 12:30pm | Replies (116)

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@gailg

I have been on this blog for several years and it has preserved my sanity. I've seen multiple doctors, and they all say it can't be PMR because I have normal blood markers, but from symptoms I know it is. I can't find a Rheumatologist that will see me because the markers are normal. Long shot, are any of you that have normal markers but are seeing a Rheumatologist in Colorado??

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Replies to "I have been on this blog for several years and it has preserved my sanity. I've..."

Hi @gailg, I can't answer your question about doctors in Colorado,but I had full onset PMR for about seven months and my inflammation markers were only slightly elevated - such that my PCP took no notice. Eight months later, I had a host of strange symptoms, and my inflammation markers were highly elevated. I had GCA.
Absent the inflammation markers, and with symptoms of PMR, one medical textbook's chapter on PMR suggests a diagnostic trial dose of prednisone, 15 - 20 mg. If there is a dramatic clinical response, it says treat as PMR. If there isn't a response, other disorders to consider - connective tissue disorder, hypothyroidism, infection, malignancy. (Goldman and Sach's Textbook of Medicine)
I also found an article which addresses this isswue.

Table I
A four-point guidance on how to investigate PMR when normal ESR and CRP coexist

1.
In an older person complaining of chronic bilateral shoulder and hip girdle pain associated with inflammatory morning stiffness, a possible PMR can be considered (even if ESR and CRP are both normal) if the proposed therapies do not improve pain and self care
2.
An ultrasound examination of shoulder and hip girdle as well as the measurement of other biomarkers in adjunct to ESR and CRP can give additional information
3.
A fast and significant improvement after a few days (seven days, on average) of low-dosed prednisone can confirm the first diagnostic suspicion, but it should be kept in mind that a watchful follow-up is mandatory
4.
Several diseases can mimic PMR in some clinical features and in positive response to low-dose prednisone. They must be carefully excluded (not only at the beginning but also after follow-ups). The possibility of occult GCA should be investigated.

Here's the link to the article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911650/
I wish you the best, and an answer!