Do I have polymyalgia rheumatica?

Welcome @charlotte61, Your symptoms certainly sound like PMR but there are other conditions that mimic PMR. I'm not a doctor and have no medical training but I have had PMR twice and the first time it came on me similar to what you are describing. My primary care doc referred me to a rheumatologist who diagnosed me with PMR pretty quick after an exam and describing my symptoms to him. He prescribed 20 mg prednisone and within a few hours of taking my first dose all the pain was gone until the next morning when I needed to take my second dose. You might want to ask the doctor for a trial package of prednisone to see if your symptoms respond to the prednisone. If they do, it could confirm the diagnosis for the doctor. The other option is to ask for a referral to a rheumatologist. You might find the following references helpful for asking questions with your doctor.

--- The Productive Rheumatology Appointment Guide - Learn how to take back control of your appointments and healthcare!: https://connectedrheumatology.com/the-productive-rheumatology-appointment-guide
--- Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica: https://ard.bmj.com/content/early/2023/02/23/ard-2022-223429.

Have you thought about seeking a second opinion with a rheumatologist?

Hi there- I’m so sorry you’re experiencing this. From watching my dad struggle with PMR, and even though I have an inflammatory arthritis, it was still shocking how debilitating the pain and fatigue was.

What you’ve shared does sound a lot like PMR, but there are many other inflammatory and other conditions that can be very similar. I’m not a doctor but if your inflammatory markers (ESR and CRP) are very elevated, this makes it much more likely to be PMR. But at the same time other thing should push up those blood tests, and it’s still possible not to have elevated inflammatory markers. That combined with your symptoms and a trial dose of prednisone could confirm the diagnosis very quickly.

A PCP can treat PMR, and many do when rheumatologists aren’t available, but it’s been my experience that it’s still ideal to work closely with a rheumatologist because there’s so much nuance with these types of conditions and managing them with medications.

As for pain…well for my dad, no pain reliever touched the pain. Then again that’s sort of one of the hallmarks of the condition. I would think NSAIDs (ibuprofen, etc.) may help if it is PMR or an inflammatory condition, but I know it’s rare for older adults (or many people really) to be able to safely take NSAIDs.

Otherwise ice or heat, rest and a lot of deep breathing, perhaps?

I’m really hoping for you that you get clarity soon and the blood tests are revealing.

My rheumatologist told me not to take NSAIDs while taking Prednisone.

Once the tests for inflammation are drawn at the lab it is OK to start on
prednisone. Advocate for a trial of therapy with your primary doctor.

Right, that makes complete sense. I only mentioned it because it sounded like they were asking about things to do for pain while waiting for initial lab results and before prednisone's been prescribed. It's my understanding that Tylenol isn't usually effective for inflammatory pain.

Until the diagnosis, my doctor had me taking 650mg Tylenol and 200mg Advil together every 4-6 hours while awake. After Prednisone began, she said that I could take Tylenol when needed but not to take Advil or aspirin.

Glad you are with doctor. I am 3 years into it. No pain pill works. Been on prednisone, now 3 years and current dose 8 mg. Yes beginning was depressed discouraged etc. better, but not best. Still on tapering off phase. Pain for me middle of night. Keep up physical activity at all cost. Just modify. Best thing has been this Mayo group and I check usually daily need the comradeship.

Thanks for your feedback, everyone -- it's much appreciated! My doctor called this morning to confirm a diagnosis of polymyalgia rheumatica, based on my blood test results. I'm just about to go pick up a prescription of prednisone to start treatment. I'm a little anxious about taking prednisone, especially as I already have osteoporosis, but I've been doing some research on diet and making a list of things to eat that will give me more calcium and vitamin D. I am also cutting red meat, processed foods, and margarine out of my diet. I don't have a rheumatologist at this time, and it would probably take months to get to see one. I'm also looking at exercise -- I love walking, gardening, swimming and I also attend Tai chi classes twice a week, although I've hardly been doing anything the past couple of weeks because of the pain, and the fact that too much exercise seemed to make me feel worse the next day. Thanks again for the info you have provided me with. This might be a long journey, but once the pain and stiffness have settled down, I look forward to getting my life back. I'm also wondering if physical therapy would help -- has anyone tried this as well?

Hi Charlotte, I am sorry that you have received this diagnosis but at least you now know what has been causing your awful pain. When you begin prednisone you will probably experience a amazing decrease/end of your joint pain. You didn’t mention how many mg you will be taking. For me the 25mg was not enough at first so my dr. increased it to 30, which worked like a charm. After a while I started to taper (under the dr. supervision.) A couple of things to consider. I am now taking a bunch of daily supplements: 1000 calcium (divided), 2000 vit D, vit K(to help the calcium get into bones), Pepcid (dr. said it will prevent stomach bleeds from Prednisone). I have been diagnosed with osteopenia and my last dexa scan results look like it is trending towards osteoporosis. Dr. advised me to begin taking fozamax, so I am. Like you, I am an exerciser, walking several miles daily, yoga 2x per week and lots of golf. I would definitely keep up your exercise but just not too strenuously (listen to your body). As far as PT, you could wait a bit to see if your pain diminishes after taking prednisone. If you still have body aches, there might be something else going on and PT may help. Believe me, I was not a fan of taking prednisone, but not being able to get out of bed without excruciating pain made me a believer. As many others have said in this support group, quality of life is so important. Be patient and let us know how you are doing.
Liz Ward
PS. I too am now pretty strict about diet. Pretty much Mediterranean diet with little/no red meat, no salt or sugar, no white flour or processed foods. I do believe it has helped off set some of prednisone’s side effects (bloating and weight gain) plus keeping inflammatory foods out of my system.

For your piece of mind get your doctor to order a bone density scan, their are medications he can prescribe.