PMR initial diagnosis: Can there be an underlying disease?

Hi guys!

Been to a GP many times and have an appointment with a Rheumy on Monday, but I'm hoping to get some third, fourth and fifth opinions before going on Prednisone at 31. Any input would be greatly appreciated.

I'm pretty healthy, exorcised frequently before this, and have never had any serious health issues prior to this as well. I did drink too much in my 20's but have all but stopped at this point.

I'll start with a quick walk through of the progression of my symptoms.

3.5 MONTHS AGO

I noticed rash patches had developed all over my scalp. They were causing some serious dandruff -- never had anything like this before. Was worried it might be Psoriasis, but the doc. said it's scalp eczema, which makes sense because I had eczema as a kid.

2.5 MONTHS AGO

Developed Plantir Fascitis in both feed (I'm active, not overweight, and have never had it before in my life). After some rest it went away it my right foot but I basically still can't walk on my left foot.

Started developing pain in my right index finger. Chalked it up to overuse as I work as a developer and, well, that's the finger I click the mouse with. Doc. also said that it was Tendonitis and to just lay off it for a bit. I started using a finger splint and the pain seemed to get a little better after about two weeks, but then...

2 MONTHS AGO

Started developing a tenderness in my upper vertebrae, then it started hurting when I would bend over or get up out of bed. I went to the doctor again and mentioned I use kettle-bells for working out and he said it was probably just a stress injury from that and unrelated to my finger pain/scalp rashes. He told me to lay off the weights for a bit.

Over the course of the next week or two, the pain just kept spreading and getting worse. My spine is tender from about half-way up to the neck now, it's in both of my shoulders, the front of my hip bones, my right wrist, and upper arms. Now my ribs are tender when I press on them as well. It's excruciating to roll over in bed, and takes a concerted effort to sit up and get out of be. I can also hardly put my socks on. The pain in my index finger has subsided somewhat, but I started using my middle finger for the mouse instead and then it swelled up to the size of a sausage, became incredibly painful to bend and literally impossible to bend more than half way -- I've been keeping it in a splint and icing it daily for weeks now.

TREATMENT

Two months ago, when the pain first started really spreading, the doc. gave me a Naproxen prescription and I took two 500mg/day. for a month. It seemed to help somewhat with the pain a few hours after taking it, but only about a 40-50% reduction.

After I ran out of Naproxen, the doc. said we can try and knock it out with a short course of Prednisone -- so I did a week of Prednisone at 40mg for three days and 20mg for four days.

The Prednisone completely relieved my symptoms at first, but by the last day some of the pain had come back and after I stopped it all came back with a vengeance.

Now the doctor has sent off a referral to a Rheumatologist to get a second opinion before starting me on a year+ of Prednisone (the only known effective treatment for PMR).

DIAGNOSE ME

Please, if there are any doctors out there, could you have a look at my labs and see if this diag. makes sense?

The blood work seems to indicate inflammation for sure, and there are no RF factors, but the avg. age of PMR onset is 70, with is being extremely rare in people under 50. Furthermore, the swollen fingers, Plantir Fascitis, and scalp rashes don't seem to be common symptoms of PMR.

Very keen to get any more professional opinions.

I also just had two chest X-rays and an X-ray on my right hand done, as well as a blood test for my calcium levels (in case of hypo/hyperthyroidism -- I read that's a possible differential) and some test for gout (although it's probably definitely not gout as it's all over my body) -- I've attached the X-rays diag. below and will update with the additional bloods as soon as I get them back.

BLOODS

Abnormalities:

ESR: 28mm/hr

CRP: 28mg/L

ANA Titre: 1:80, speckled pattern (doc. said this was essentially nominal)

Platelets: 447 x 10e9/L (again, doc. said this was nothing to worry about)

Full bloods and X-ray diagnosis attached.

Hi guys!

Been to a GP many times and have an appointment with a Rheumy on Monday, but I'm hoping to get some third, fourth and fifth opinions before going on Prednisone at 31. Any input would be greatly appreciated.

I'm pretty healthy, exorcised frequently before this, and have never had any serious health issues prior to this as well. I did drink too much in my 20's but have all but stopped at this point.

I'll start with a quick walk through of the progression of my symptoms.

3.5 MONTHS AGO

I noticed rash patches had developed all over my scalp. They were causing some serious dandruff -- never had anything like this before. Was worried it might be Psoriasis, but the doc. said it's scalp eczema, which makes sense because I had eczema as a kid.

2.5 MONTHS AGO

Developed Plantir Fascitis in both feed (I'm active, not overweight, and have never had it before in my life). After some rest it went away it my right foot but I basically still can't walk on my left foot.

Started developing pain in my right index finger. Chalked it up to overuse as I work as a developer and, well, that's the finger I click the mouse with. Doc. also said that it was Tendonitis and to just lay off it for a bit. I started using a finger splint and the pain seemed to get a little better after about two weeks, but then...

2 MONTHS AGO

Started developing a tenderness in my upper vertebrae, then it started hurting when I would bend over or get up out of bed. I went to the doctor again and mentioned I use kettle-bells for working out and he said it was probably just a stress injury from that and unrelated to my finger pain/scalp rashes. He told me to lay off the weights for a bit.

Over the course of the next week or two, the pain just kept spreading and getting worse. My spine is tender from about half-way up to the neck now, it's in both of my shoulders, the front of my hip bones, my right wrist, and upper arms. Now my ribs are tender when I press on them as well. It's excruciating to roll over in bed, and takes a concerted effort to sit up and get out of be. I can also hardly put my socks on. The pain in my index finger has subsided somewhat, but I started using my middle finger for the mouse instead and then it swelled up to the size of a sausage, became incredibly painful to bend and literally impossible to bend more than half way -- I've been keeping it in a splint and icing it daily for weeks now.

TREATMENT

Two months ago, when the pain first started really spreading, the doc. gave me a Naproxen prescription and I took two 500mg/day. for a month. It seemed to help somewhat with the pain a few hours after taking it, but only about a 40-50% reduction.

After I ran out of Naproxen, the doc. said we can try and knock it out with a short course of Prednisone -- so I did a week of Prednisone at 40mg for three days and 20mg for four days.

The Prednisone completely relieved my symptoms at first, but by the last day some of the pain had come back and after I stopped it all came back with a vengeance.

Now the doctor has sent off a referral to a Rheumatologist to get a second opinion before starting me on a year+ of Prednisone (the only known effective treatment for PMR).

DIAGNOSE ME

Please, if there are any doctors out there, could you have a look at my labs and see if this diag. makes sense?

The blood work seems to indicate inflammation for sure, and there are no RF factors, but the avg. age of PMR onset is 70, with is being extremely rare in people under 50. Furthermore, the swollen fingers, Plantir Fascitis, and scalp rashes don't seem to be common symptoms of PMR.

Very keen to get any more professional opinions.

I also just had two chest X-rays and an X-ray on my right hand done, as well as a blood test for my calcium levels (in case of hypo/hyperthyroidism -- I read that's a possible differential) and some test for gout (although it's probably definitely not gout as it's all over my body) -- I've attached the X-rays diag. below and will update with the additional bloods as soon as I get them back.

BLOODS

Abnormalities:

ESR: 28mm/hr

CRP: 28mg/L

ANA Titre: 1:80, speckled pattern (doc. said this was essentially nominal)

Platelets: 447 x 10e9/L (again, doc. said this was nothing to worry about)

Full bloods and X-ray diagnosis attached.

I have had PMR symptoms for 9 months but just diagosed a month ago. I am 53. Started 15mg Prednisone for 1 week then 10. Seemed to be ok but never pain free then woke up one morning with significant pain in shoulder and hip girdles. Didn't even exercise the day before. Has anyone had this happen? Seems very random. I'm trying to figure out the triggers of this disease so I can avoid them!

I have had PMR symptoms for 9 months but just diagosed a month ago. I am 53. Started 15mg Prednisone for 1 week then 10. Seemed to be ok but never pain free then woke up one morning with significant pain in shoulder and hip girdles. Didn't even exercise the day before. Has anyone had this happen? Seems very random. I'm trying to figure out the triggers of this disease so I can avoid them!

Seems like your dose of Prednisone may not be enough. I started at 20 mg. in January 2022 and immediately all pain was gone. Prior to this, I was pretty much completely debilitated. I'm in the process of trying to taper now, which is a bit of a roller coaster. 12.5 mg was not good, so I upped it to 13 which seems a little better and now back down to 12.5 for a couple of weeks. I had significant pain from the neck, to the shoulders, to the upper arms, to the hands (right hand looked like a claw and required a split to keep it from curling). Hips, back of thighs and buttocks were excruciating. Could not sit on the toilet and could not do the reach around. It was horrible. Your drop in dosage seems to be too much and so the inflammation is likely building up again. Talk with your GP or Rheumatologist about increasing the dosage for awhile. It takes time for your body to settle in and we MUST listen to our bodies. Everyone is different. Cheers!

Thank you. I am back down to very little pain/discomfort/stiffness now - probably about a 2, which I can definitely live with. It was bad that first day then gradually got better. Took about 5 days. Wondering if that is just how PMR goes? I had been on the 10mg for about 2 weeks when I woke up hurting so badly again. Seems like the Pred was working at that level before that day then it wasn't...now it is. I am just trying to learn more about how this disease flows.

Thank you. I am back down to very little pain/discomfort/stiffness now - probably about a 2, which I can definitely live with. It was bad that first day then gradually got better. Took about 5 days. Wondering if that is just how PMR goes? I had been on the 10mg for about 2 weeks when I woke up hurting so badly again. Seems like the Pred was working at that level before that day then it wasn't...now it is. I am just trying to learn more about how this disease flows.

Hi guys!

Been to a GP many times and have an appointment with a Rheumy on Monday, but I'm hoping to get some third, fourth and fifth opinions before going on Prednisone at 31. Any input would be greatly appreciated.

I'm pretty healthy, exorcised frequently before this, and have never had any serious health issues prior to this as well. I did drink too much in my 20's but have all but stopped at this point.

I'll start with a quick walk through of the progression of my symptoms.

3.5 MONTHS AGO

I noticed rash patches had developed all over my scalp. They were causing some serious dandruff -- never had anything like this before. Was worried it might be Psoriasis, but the doc. said it's scalp eczema, which makes sense because I had eczema as a kid.

2.5 MONTHS AGO

Developed Plantir Fascitis in both feed (I'm active, not overweight, and have never had it before in my life). After some rest it went away it my right foot but I basically still can't walk on my left foot.

Started developing pain in my right index finger. Chalked it up to overuse as I work as a developer and, well, that's the finger I click the mouse with. Doc. also said that it was Tendonitis and to just lay off it for a bit. I started using a finger splint and the pain seemed to get a little better after about two weeks, but then...

2 MONTHS AGO

Started developing a tenderness in my upper vertebrae, then it started hurting when I would bend over or get up out of bed. I went to the doctor again and mentioned I use kettle-bells for working out and he said it was probably just a stress injury from that and unrelated to my finger pain/scalp rashes. He told me to lay off the weights for a bit.

Over the course of the next week or two, the pain just kept spreading and getting worse. My spine is tender from about half-way up to the neck now, it's in both of my shoulders, the front of my hip bones, my right wrist, and upper arms. Now my ribs are tender when I press on them as well. It's excruciating to roll over in bed, and takes a concerted effort to sit up and get out of be. I can also hardly put my socks on. The pain in my index finger has subsided somewhat, but I started using my middle finger for the mouse instead and then it swelled up to the size of a sausage, became incredibly painful to bend and literally impossible to bend more than half way -- I've been keeping it in a splint and icing it daily for weeks now.

TREATMENT

Two months ago, when the pain first started really spreading, the doc. gave me a Naproxen prescription and I took two 500mg/day. for a month. It seemed to help somewhat with the pain a few hours after taking it, but only about a 40-50% reduction.

After I ran out of Naproxen, the doc. said we can try and knock it out with a short course of Prednisone -- so I did a week of Prednisone at 40mg for three days and 20mg for four days.

The Prednisone completely relieved my symptoms at first, but by the last day some of the pain had come back and after I stopped it all came back with a vengeance.

Now the doctor has sent off a referral to a Rheumatologist to get a second opinion before starting me on a year+ of Prednisone (the only known effective treatment for PMR).

DIAGNOSE ME

Please, if there are any doctors out there, could you have a look at my labs and see if this diag. makes sense?

The blood work seems to indicate inflammation for sure, and there are no RF factors, but the avg. age of PMR onset is 70, with is being extremely rare in people under 50. Furthermore, the swollen fingers, Plantir Fascitis, and scalp rashes don't seem to be common symptoms of PMR.

Very keen to get any more professional opinions.

I also just had two chest X-rays and an X-ray on my right hand done, as well as a blood test for my calcium levels (in case of hypo/hyperthyroidism -- I read that's a possible differential) and some test for gout (although it's probably definitely not gout as it's all over my body) -- I've attached the X-rays diag. below and will update with the additional bloods as soon as I get them back.

BLOODS

Abnormalities:

ESR: 28mm/hr

CRP: 28mg/L

ANA Titre: 1:80, speckled pattern (doc. said this was essentially nominal)

Platelets: 447 x 10e9/L (again, doc. said this was nothing to worry about)

Full bloods and X-ray diagnosis attached.