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PMR initial diagnosis: Can there be an underlying disease?
Polymyalgia Rheumatica (PMR) | Last Active: Jul 4, 2022 | Replies (49)Comment receiving replies
Hello, I am new to the PMR diagnosis and new to this group. Thank you for your support and insight provided to the members.
I have been a very active and healthy 65 year old female except for having some degenerative disc disease in my lower back, eczema flare ups and Irritable Bowel Syndrome ...until, I woke up the first part of April with excruciating pain in my shoulders and upper back. A few days later my hips, thighs and eventually my knees ached horribly especially in the morning or after sitting for an extended time. i suspected PMR and had a conversation with my GP who dismissed the possibility and put me on gabapentin because i was also having nerve pain in my leg that prevented me from sleeping.
The pain in my shoulders and hips continued to get worse, so i made an appointment with a Rheumatologist who did ESR and CRP (normal) and xrays of my hips and shoulders (normal). Although my blood work was in the normal range, I was a bit persistent with trying a course of prednisone because i know that a small % of people can have normal values. In addition, i was aware of how responsive PMR is to steroid treatment. I started with 10 mg and within 24 hours i had no shoulder pain and within 36 no hip or thigh pain. This week, after 4 weeks of being on 10 mg, i will taper 1 mg a month.
My question is if that is a reasonable treatment strategy since i have no pain whatsoever. I would certainly prefer not to be on a steroid any longer than i have to be. My other question, is because i was sort of persistent with obtaining the PMR diagnosis, could it be something else that i am missing? All autoimmune markers were normal too (no rheumatoid arthritis, lupus, etc. etc.) All other blood work is normal.
Thank you for your time and assistance.
Replies to "Hello, I am new to the PMR diagnosis and new to this group. Thank you for..."
Hello @irishdancer, I would like to add my welcome to Connect along with @karinaph. You will notice that we merged your post with an existing discussion on the same topic. If you click the VIEW & REPLY button at the bottom of the email notification it will take you to the discussion where you can meet other members with similar symptoms and questions and learn what they have shared.
Here's an excerpt from the article below that gives some insight on why PMR can mimic other conditions and be hard to diagnose.
"Feb 28, 2018 - In our medical records (data unpublished), six amongst 265 PMR patients had normal values of both ESR and CRP at diagnosis. The vast majority of these patients had no constitutional manifestations. The reasons why this can be possible in an auto-inflammatory disease are only speculative." -- Polymyalgia rheumatica with normal values of both erythrocyte sedimentation rate and C-reactive protein concentration at the time of diagnosis: a four-point guidance: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911650/
I think your treatment strategy is reasonable and I would probably discuss a taper schedule with your doctor or rheumatologist. I've tried various tapering off schedules during my 2 occurrences of PMR, usually changing dosage on a weekly basis. The first time took me 3-1/2 years to taper off with the last 6 months going between 1/2 mg and 1 mg until I was finally able to stop taking it with no or relatively no pain.
Do you keep a log of your dosage and a pain scale for the day? I found that to be helpful for both of my occurrences of PMR.
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I too had semi “normal” blood results. I think one factor was out of wack, but didn’t scream PMR. They chose to try me on prednisone to see if I responded and I did. Though in my efforts to taper I have not been successful. Actually having GCA, giant cell arteritis symptoms ( sedimentation rate did not correlate), but symptoms were severe and exact. So, I’m back up to 14 and will attempt to drop 1 mg in Oct. It’s interesting that you knew about PMR, I had never heard of it. Good luck with your treatment, sounds like you’re on a good path.