Do I really have PMR?

Posted by englerbarb @englerbarb, Aug 31, 2021

Hi. First of all, I’m so glad I’ve found this group! I was diagnosed with PMR 4 days ago and started taking 20mg Prednisone 3 days ago. I already feel so much better and am hoping for no, or few side effects. I’m wondering if any of you who have PMR had normal inflammatory markers at the time of your diagnosis. I found out today from my doctor that mine are normal, so she thinks it might be something other than PMR. Do any of you have experience with this too? I’ll be going back to the lab to get more testing done in another week and a half. If I don’t have PMR, why would the prednisone work for my pain and what else could it be other than PMR?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@jfannarbor

I think I have a very unusual presentation of PMR and have often wondered if I have PMR or something else. I would appreciate any comments on my history. About 35 years ago I started to have pain for no reason in (shoulder girdle and hip girdle. I went to see a Rheumatologist who Rx prednisone (P) 10 mg per day immediately because description and type of pain I described was straight out of a text book even though I had no idea of what PMR was. We found out later due to blood tests ordered at that first appointment that my Sed rate and CRP were normal and have always been normal. Within 6 hours of taking prednisone, I was a new man. The results were so amazing that my wife saw the difference before I told her what I was doing. Now the strangeness begins. I tapered off P and all was fine for about a year and then PMR returned. I went on P and things were fine for a year. This cycle went on for 20 years with the time between P becoming less. In the last 35 years I have seen 3 other rheumatologists and about 10 years ago went on 2.5 mg of P daily and just recently I have gone on 5 mg of P daily since the pain and stiffness have gotten worse. The second rheumatologist I saw did the most complete physical examination I have every had related to PMR and after being one on one with him for an hour and 40 minutes he said, "I don't think you have PMR, but I do not know what you have." The third rheumatologist I saw said that if my symptoms were solved by 2.5 mg of P that anything else he could do would not be as good due to side effects and cost. The last rheumatologist I saw realized that I was stiff and in pain and decided to go on 5 mg of P and see how my bone density responds in a year. After 10 years on 2.5 mg P per day my bone density was normal or above normal for a 77 yo male. Probably due to the excessive amount of exercise I do 5-6 days a week.
I think I have PMR, but the presentation I do not think is usual and the last rheumatologist first thought that I didn't have PMR, and still is not convinced due to the early on set of the disease. I probably had PMR before I was 40 since I thought the pain I was having was due to the excessive amount of exercise I have done my whole life.

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PMR is not a well diagnosed or treated disease. Prednisone does NOT stop pain in my case.
Good luck. It’s changed my life and no one can help.

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@macferse

Hi Englebarb, Itta, John Bishop.
I had PMR 10 years ago, successfully treated with Prednisolone. Started experiencing exacay the same pattern of pains in March 2022 and was convinced it was a recurrence. Neither ESR or CRP were raised. I had to prompt my GP to test consecutively for all potential conditions with a similar pattern of symptoms, before he sent me to a Rheumatologist. It took 10 months for my them to take it seriously. Rheum. told me I was a very unusual lady, that it was very rare to have it twice 10 years apart. 20mg of Prednisolone took the pain away in 36 hours.
Thank everyone for sharing their experiences!

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Horrible! What's with these doctors that don't LISTEN to their patients, who often KNOW their bodies and what's going on!?!?
From what I've read/heard, it is not unusual at all to have a reoccurrence, regardless of the time frame.
I'm left wondering how long you will have to be on the (strong) prednisolone? It's such a damaging drug. (doesn't take away my pain, which renders it useless to me)

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My inflammatory markers all went away within the first MONTH of my diagnosis and Prednisone treatment.
However, the PAIN, fatigue, loss of appetite, and general depression have only worsened. (Prednisone does NOT take away my pain at all !?)
Even with my inflammation markers all being 'normal' for over 6 months now, I still have PMR. Go figure. I continue to believe that PMR is a weakly diagnosed (and treated) problem. PMR=Prednisone=more PMR= more Prednisone. I'm told this may last what's left of my lifetime.

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@keelin

My inflammatory markers all went away within the first MONTH of my diagnosis and Prednisone treatment.
However, the PAIN, fatigue, loss of appetite, and general depression have only worsened. (Prednisone does NOT take away my pain at all !?)
Even with my inflammation markers all being 'normal' for over 6 months now, I still have PMR. Go figure. I continue to believe that PMR is a weakly diagnosed (and treated) problem. PMR=Prednisone=more PMR= more Prednisone. I'm told this may last what's left of my lifetime.

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@keelin - If the prednisone is not providing pain relief, then maybe you don't really have PMR but a condition that mimics PMR? I know you've mentioned you've seen 2 rheumatologists in other posts earlier but if it were me I would try to ask a bunch of "why is the pain not being addressed by the treatment" questions and maybe seek help at a teaching hospital or major health facility like Mayo Clinic. I'm sure there is a treatment out there somewhere that can help.

-- Diseases that mimic polymyalgia rheumatica (PMR):
https://www.medicalnewstoday.com/articles/diseases-that-mimic-polymyalgia-rheumatica
-- Clinical manifestations and diagnosis of polymyalgia rheumatica:
https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-polymyalgia-rheumatica/print

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@johnbishop

@keelin - If the prednisone is not providing pain relief, then maybe you don't really have PMR but a condition that mimics PMR? I know you've mentioned you've seen 2 rheumatologists in other posts earlier but if it were me I would try to ask a bunch of "why is the pain not being addressed by the treatment" questions and maybe seek help at a teaching hospital or major health facility like Mayo Clinic. I'm sure there is a treatment out there somewhere that can help.

-- Diseases that mimic polymyalgia rheumatica (PMR):
https://www.medicalnewstoday.com/articles/diseases-that-mimic-polymyalgia-rheumatica
-- Clinical manifestations and diagnosis of polymyalgia rheumatica:
https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-polymyalgia-rheumatica/print

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I do not share your optimism, having actively pursued two GP’s opinions,
and two Rheumatologists’ opinions, and a Pain Management Clinic.

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@keelin

PMR has no exact tests to diagnose it. Doctors go by symptoms and usually inflammatory markers are raised. But even that doesn’t prove you have PMR.
Read up on the prednisone. It doesn’t do much of anything for my pain, but it sure causes side effects! Doctors just love putting patients on prednisone and walking away. Seems easy. Meanwhile, what happening to your body? Only you can care.
Be careful.
And remember- Doctors “practice,” they don’t KNOW much, especially about PMR!

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I may have been misdiagnosed with PMR in March of 2021 and took Prednisone for over a year and a half! Then I went to another rheumatologist who thinks that I never had PMR because I only had pain while laying down and I had no inflammatory markers. Now it seems like my pain could have been cervical radiculopathy all this time!

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@johnbishop

@jfannarbor, There are conditions that can mimic PMR and it's not uncommon to have PMR with normal CRP and SED rates from what I've read.
-- Diseases that mimic polymyalgia rheumatica (PMR):
https://www.medicalnewstoday.com/articles/diseases-that-mimic-polymyalgia-rheumatica
-- Polymyalgia rheumatica: Look before you leap:
https://bpac.org.nz/bpj/2013/june/polymyalgia-rheumatica.aspx
If you do have PMR, too much exercise can elevate the pain levels, at least it has when my PMR was active. I know you've mentioned seeing several different rheumatologist but have you thought about seeking help at a major teaching hospital or health facility like Mayo Clinic?

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Responding to @jchnbishop. Three of the four rheumatologists were at the University of Michigan Hospital system. I have also been to U of M muscular dystrophy clinic. I am not sure how my extensive exercise schedule affects my condition. I am sure it complicates the Dx since MDs tell me that I am at the 99th percentile with reguards exercise. I honestly feel that exercise makes me feel better.

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@keelin

Horrible! What's with these doctors that don't LISTEN to their patients, who often KNOW their bodies and what's going on!?!?
From what I've read/heard, it is not unusual at all to have a reoccurrence, regardless of the time frame.
I'm left wondering how long you will have to be on the (strong) prednisolone? It's such a damaging drug. (doesn't take away my pain, which renders it useless to me)

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I know that prednisone has side effects. Can you imagine if we didn't have anything like prednisone? Medicine doesn't have good answers for every condition. Just look at cancer and we had a war on cancer over 50 years ago.

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I've had PMR for almost 3 years now and just came across an interesting website that explains PMR in a more technical way. Lots of interesting information there but sometimes a little over my head. Good luck with your diagnosis. PMRandIL6.com

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PMRand IL6.com is a good website but I had a heck of a time getting my computer to send me there because there is so much research requests on diabetes. I suggest putting a space in like this, PMR and IL6.com, that worked for me. In my research, I kept coming up with the importance of IL6 and that is why I take MSM which down regulates it. I am convinced it has saved me from a relapse a couple of times. MSM doesn't seem to have side effects and is easy to get so I think everyone should try it. Look it up. It is the real deal. I take 3 gm early in the morning with a little juice. Easy peasy.

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