New to PMR - Are Monthly Labs and Check-ups normal?

Posted by abbeyc @abbeyc, Mar 28, 2022

Hello, I am kind of new. 3 months with PMR but I am wondering how everyone is dealing with their doctors. So far my Rheumatologist is saying I need to see him once per month for labs and then check-up/medication recommendations (starting to taper). This will get very expensive with monthly doctor visits for what I understand will be YEARS of PMR. Is everyone doing this? or managing somehow on their own? But we need to the docs to write the prescriptions obviously.

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

Profile picture for chzuck @chzuck

I was diagnosed in 2020 with PMR by my family doctor. He treated me for a time, changing my dose weekly. Told him repeatedly I did not want to be on Prednisone for a long time, to which it appeared he turned a deaf ear.
Next went to a Rheumatologist with almost the same treatment, except monthly changes and an insistence on splitting the does in half and taking morning and evening. I told the doc I wanted off and so I gradually reduced the dose to 3 or 4 mg/day. I could not operate like that, so back on at 10 or 15mg and taper down at 1mg/month. Seems that is all I have been doing. Finally in May I said I am not dropping for the summer, I want to feel good enough to do things. Prednisone has given me thin skin. My arms have blotches all over. A slight bump or brush and my skin is ripped and I am bleeding. Finally at my insistence for something else, I am being evaluated for methotrexate. Looking for experiences others have had with PMR. The two markers I get tested get tested for every two months, CRP and Sed Rate, almost never reflect my pain/discomfort level. The only time those results were high is when I was first diagnosed. I think it a waste of time even doing them.

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So sorry you are having trouble with your dosage of prednisone. PMR is a tricky condition that interferes with our normal everyday life. I was fortunate to meet my rheumatologist in the ER when I was already nonfunctional. My sed rate was 98 with very high CRP. When I had my first office visit he told me, If you want to get off Prednisone, follow my direction for a gradual tamper. If you go back and forth on dosage, you will never get off! That was his advice. I have gone from 15mg down to 7mg in 9 months with no flare ups.
Wishing you a successful journey with this tricky condition!

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How often does your doctor do bloodwork to check on your inflammation markers for PMR? Any other bloodwork you have done specific to the PMR?

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Profile picture for cj762 @cj762

How often does your doctor do bloodwork to check on your inflammation markers for PMR? Any other bloodwork you have done specific to the PMR?

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@cj762 - You will notice that we merged your post into an existing discussion on the same topic so that you can connect with others asking the same or similar questions and learn what they have shared. If you click the link below, it will take you to the beginning of the discussion:
-- New to PMR - Are Monthly Labs and Check-ups normal?: https://connect.mayoclinic.org/discussion/doctor-schedule/

My inflammation markers were checked during my yearly checkup when my PMR was active and my PCP checks them yearly now.

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Profile picture for chzuck @chzuck

I was diagnosed in 2020 with PMR by my family doctor. He treated me for a time, changing my dose weekly. Told him repeatedly I did not want to be on Prednisone for a long time, to which it appeared he turned a deaf ear.
Next went to a Rheumatologist with almost the same treatment, except monthly changes and an insistence on splitting the does in half and taking morning and evening. I told the doc I wanted off and so I gradually reduced the dose to 3 or 4 mg/day. I could not operate like that, so back on at 10 or 15mg and taper down at 1mg/month. Seems that is all I have been doing. Finally in May I said I am not dropping for the summer, I want to feel good enough to do things. Prednisone has given me thin skin. My arms have blotches all over. A slight bump or brush and my skin is ripped and I am bleeding. Finally at my insistence for something else, I am being evaluated for methotrexate. Looking for experiences others have had with PMR. The two markers I get tested get tested for every two months, CRP and Sed Rate, almost never reflect my pain/discomfort level. The only time those results were high is when I was first diagnosed. I think it a waste of time even doing them.

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@chzuck as @razhuny and @kipster have said, prednisone has to be tapered over a period of months. My husband went through eighteen months of tapering till he could get off it. It’s a protocol that needs to be followed. If you don’t, your PMR will keep coming back with a vengeance!

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Profile picture for rashida @rashida

@chzuck as @razhuny and @kipster have said, prednisone has to be tapered over a period of months. My husband went through eighteen months of tapering till he could get off it. It’s a protocol that needs to be followed. If you don’t, your PMR will keep coming back with a vengeance!

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@rashida Long time since I updated my story. There seems to be varying opinions on how to taper. The Rheumatolgist I just fired had me taper 1/2mg/mo. My current one said drop 1mg, then a week later stop completely. I have been prednisone free since April 2. Now a little more info is needed for the statement above.
I started researching on my own and learned PMR is usually hips and shoulders. I was telling my fired Rheumatoligist that my legs hurt so when doing the trim mowing around my house and that when I got completely around, it seemed that my legs were done and could not go anymore. That is when she put me on Methotrexate and when I did not get any improvement, Hydroxychloroquine. I was on that a month or two with no improvement that I told her about my research findings. She had me get off one then the other. My leg pain was coming from issues in my back. I had talked to others about their PMR and they would tell me that when it hit them they could not move because of pain. I never had that. My primary care doctor diagnosed PMR when I went to him with pain in my left should when I would reach above my head. Personally I don't think I had PMR, but an arthritis flareup. I can reach above my head without pain. One really needs to do the research on whatever medical issue you have. Be informed!

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Profile picture for cj762 @cj762

How often does your doctor do bloodwork to check on your inflammation markers for PMR? Any other bloodwork you have done specific to the PMR?

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@cj762
My initial blood work 10 month ago was Arthritis panel, ESR and CRP, Creatine Kinase, Magnesium, TSH (Thyroid), CBC and Comprehensive Metabolic panel. Since then, I had CRP and ESR redone 6 months ago (still negative).
Then I got a Rheumatology appointment last month and they did the following blood work:
- Rhematoid factor screen
- Anti Neutrophil Cytoplasmic Antibody ANCA
- Extractable Nuclear Antigen Antibodies
- CCP IGG/IGA
- Sjorgrens Antibodies SSB
- Sjorgrens Antibodies SSA
- Anti Proteinase 3 Antibody
- Anti Myeloperoxidase Antibody IGG
- Aldolase
- Myositis panel
- Double Stranded DNA Antibody
- High resolution Protein Electrophoresis Panel
- Anti-Thyroid Peroxidase Antibody
- Anti-Nuclear Antibodies (ANA)

And after all that, because CRP and ESR were normal,
I was still was diagnosed as Seronegative PMR because 15mg prednisone
make me able to walk stairs and be able to function during the day.

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Profile picture for tsesow @tsesow

@cj762
My initial blood work 10 month ago was Arthritis panel, ESR and CRP, Creatine Kinase, Magnesium, TSH (Thyroid), CBC and Comprehensive Metabolic panel. Since then, I had CRP and ESR redone 6 months ago (still negative).
Then I got a Rheumatology appointment last month and they did the following blood work:
- Rhematoid factor screen
- Anti Neutrophil Cytoplasmic Antibody ANCA
- Extractable Nuclear Antigen Antibodies
- CCP IGG/IGA
- Sjorgrens Antibodies SSB
- Sjorgrens Antibodies SSA
- Anti Proteinase 3 Antibody
- Anti Myeloperoxidase Antibody IGG
- Aldolase
- Myositis panel
- Double Stranded DNA Antibody
- High resolution Protein Electrophoresis Panel
- Anti-Thyroid Peroxidase Antibody
- Anti-Nuclear Antibodies (ANA)

And after all that, because CRP and ESR were normal,
I was still was diagnosed as Seronegative PMR because 15mg prednisone
make me able to walk stairs and be able to function during the day.

Jump to this post

@tsesow All I know is my new doc has done far far more testing than my previous doc and I am off Prednisone I do not have anymore pain. On the downside, Prednisone already did the damage. I have stress fractures in the T11, T12 and L1 area. The last visit more testing of which I do not have the results.

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Profile picture for chzuck @chzuck

@tsesow All I know is my new doc has done far far more testing than my previous doc and I am off Prednisone I do not have anymore pain. On the downside, Prednisone already did the damage. I have stress fractures in the T11, T12 and L1 area. The last visit more testing of which I do not have the results.

Jump to this post

@chzuck I am happy to report that after one year of treatment and final prednisone taper, my PMR experience is over. My shoulders and hips want it to never return. To those new to PMR there is hope.
JM-Puyallup WA

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Profile picture for chzuck @chzuck

@rashida Long time since I updated my story. There seems to be varying opinions on how to taper. The Rheumatolgist I just fired had me taper 1/2mg/mo. My current one said drop 1mg, then a week later stop completely. I have been prednisone free since April 2. Now a little more info is needed for the statement above.
I started researching on my own and learned PMR is usually hips and shoulders. I was telling my fired Rheumatoligist that my legs hurt so when doing the trim mowing around my house and that when I got completely around, it seemed that my legs were done and could not go anymore. That is when she put me on Methotrexate and when I did not get any improvement, Hydroxychloroquine. I was on that a month or two with no improvement that I told her about my research findings. She had me get off one then the other. My leg pain was coming from issues in my back. I had talked to others about their PMR and they would tell me that when it hit them they could not move because of pain. I never had that. My primary care doctor diagnosed PMR when I went to him with pain in my left should when I would reach above my head. Personally I don't think I had PMR, but an arthritis flareup. I can reach above my head without pain. One really needs to do the research on whatever medical issue you have. Be informed!

Jump to this post

@chzuck @rashida
What took me months to realize is PMR doesn't come back, it never left. Tapering Prednisone issues seem to depend on the dosage and importantly the length of time on P. It has it's own issues and tapering should look to how inhibited the adrenal glands have gotten. PMR (seems from all these comments) might burn itself out after 2 or so years. If tapering P gives you NO issues, then at some low P dosage, it will no longer mask the PMR pain. PMR that had never left. I am no doc and reading comments here has helped me tremendously. @dadcue has really taken time to explain things how he has experienced this. Once I read all and all other, comments, I realized whey tapering had gone with ZERO issues, then the pain came back. My P dosage was too low to mask the pain. Hope this helps.

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I have home labs done every week!

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