PMR best treated by PCP or rheumatologist?

Is the suggestion from PCP or Rheum. ? I don't know about Lyme disease tests / symptoms but one test for PMR in addition to inflamm. markers CRP and ESD (smetimes negative), is a trial with say 15 mg or max 20 mg presnisolone or prednisone for a few days which should elicit a big improvement in bilateral major joint pain (shoulders and hips both sides). 50 mg to kick off with sounds a lot to me.

Thanks, 50 seemed like a lot after reading posts here. All tests came out negative except for CRP >20 and the blood sediment test. My PCP still hasn’t gotten back to me and he is the one who talked about prescribing 50mg of prednisone.

If all your tests are negative except for the elevated CRP and ESR, and your symptoms are typical of PMR, the next step would be a trial of prednisone, roughly a dose of 15 to 25 mg once a day in the early morning. Rapid relief of symptoms within hours or a day or two would be strong confirmation of the diagnosis. As you probably know, there is no specific test that proves one has PMR, but if you meet the profile described above, it would be unlikely for you to have a different illness.

I agree with the other people that have posted that 50 mg is very high, with 15 - 20 being normal.

One benefit of seeing a rheumatologist to treat PMR is that he or she would be more familiar with GCA. 10 - 20 percent of people with PMR will also develop GCA, so it is good for people with PMR and their doctors to be aware and watchful for GCA symptoms. I developed PMR first, and GCA a few months later.

@sullyg

If you have never taken prednisone before ... 50 mg might make you feel "too good."

If you need a lot of energy for your son's wedding ... 50 mg should do the trick but it isn't a good way to boost energy. However, you might want to start at 20 mg for PMR pain. There are side effects from high dose prednisone. Prednisone is somewhat like a controlled substance when you first start taking it but then it becomes a big downer the longer you take it

A PCP can get you started. If things get complicated ... a rheumatologiy consult is a good idea.

@mark2471
There actually is a definitive test for both PMR and GCA (Giant Cell Arterits). It's called "Color Doppler Ultrasound," "Doppler Power Ultrasound," or "Musculoskeletal Ultrasound." They use it on your shoulders for PMR, and your head/temples and other spots to check for GCA.
They can see if there is fluid in the subacromial Bursa and other indicators of PMR in the shoulders.
I'm not sure what they look for to confirm GCA, but I got checked for GCA at same time as shoulders for PMR.
It's different from a standard Ultrasound machine from what I understand.
I'm not sure if they're easy to get in rural areas, but hopefully should be in many areas. It gave me definitive answers re having PMR and not having GCA.
Hope this information will help anyone who would like a definitive test.
Only wish none of us needed or wanted confirmation!!
Blessings to all of us.

I am curious as to how many PCPs are ordering biologics. My PCP is wonderful but if the prednisone tapering got problematic, I think she would be referring me to a rheumatologist.
How my diagnosis came about was my PCP sending me for hip X-Rays and to an orthopedic Dr who told me he couldn't help me. He said I should see a rheumatologist. While waiting for a rheumatologist appointment, my PCP ordered blood tests. CRP was very high 87, sed rate also 60 and I was slightly anemic. She started me on 20mg prednisone.
IMO, a rheumatologist is crucial at some point, particularly in the beginning. Always best to get your 'foot in the door' as it's easier to get an appointment down the road if you've been there before. At least that's how it's been for me. My rheumatologist is very prompt at answering if I message the office with a question. PMR can get complicated and it would be best to already have a specialist if you need one.

50mg prednisone is a drastic first step. It's easier to increase dosage than to decrease. I started on 25mg after my PMR diagnosis. I was walking (more like waddling) with a cane, not able to sleep because of the pain and I couldn't get completely dressed by myself at the time I was diagnosed. I was 6'3" and 245# at the time. I'd ask for a lower dose, as well as a referral to reach out to a rheumatologist.

The steroids will help more likely than anything else.
However it is important to have all your baseline anti
Inflammatory and rheumatologic labs done before starting steroids. A rheumatologist would not like to interpret labs affected by steroids.
Patients are often started on 25 mg for quick response
trial of prednisone. Short term for a few days may work.
My PCP gave me 25 to start after labs as it can take time to see a rheumatologist with the specialty underserved.

I agree with all the posts, 50 too high.

#1 get on prednisone and ENJOY the wedding. If it was me, I’d ask PCP for 20 mg with extra pills in bottle to “increase” if need be for wedding activities. Follow directions.
Maybe don’t 🍾🥂over enjoy.

#2 AFTER wedding book appts with Rehumy and or PCP to set a game plan.

#3 report back to us how special ❤️ the wedding was. We will still be here to help.