How easy is it to diagnose PMR?

Hi @kenners, interesting way to introduce a link to an academic paper - cat to pigeons? 🙂

For those interested the full citation of the paper is:
Authors: Sharon Cowley, Patricia Harkins, Colm Kirby, Richard Conway, David Kane,
Title: Real-world outcomes of a dedicated fast-track polymyalgia rheumatica clinic, Rheumatology, 2024;, keae531, https://doi.org/10.1093/rheumatology/keae531

Kenners, have you been diagnosed with PMR? Was it a long road to diagnosis for you?

I notice that the authors are in Ireland. A fast-track clinic is a great idea but is not likely to happen in the U.S., especially in smaller cities and rural areas. There are not enough rheumatologists and PMR is an uncommon condition. 39% of patients referred to the clinic did not have PMR so avoided exposure to prednisone. The patients who did have PMR got on prednisone within 72 hours of referral! I suffered for 4 months.

Interesting study. I doubt there will be fast track clinics anytime soon. They don’t seem to address the problem that arises when people get diagnosed with multiple autoimmune conditions.

It seems a large percentage of people are misdiagnosed … No surprises there.

I remember when I was diagnosed with PMR. It took two PCPs and three rheumatologists to figure it out. I had no clue what it was but I kept telling everyone that I needed prednisone.

My 2nd PCP was apologetic after my 3rd rheumatologist said I had PMR. The apology I received was, “Sorry… at first they thought I was a crazy person who wanted prednisone. When my third rheumatologist thought it was PMR my PCP said he thought it was PMR at the beginning of the fiasco.

Don’t get me wrong…, I respect all the doctors I have seen in the past. They knew more than me and they taught me many things. They found a way to get me off prednisone after “decades” of use. Getting off prednisone amazed me more than having a diagnosis.

I’m inclined to think my treatment with prednisone might have caused the majority of my problems.

My particular concern is that up to 40% can be misdiagnosed with harmful effects. Corticosteroids seem to be the primary way to control the condition whatever it may be until you see a rheumatologist. As this can be some time, possibly months , untold damage may occur unnecessarily. Fast track clinics may be the only answer either that or we develop several thousands of rheumatologists very quickly?

My internist did not put me on prednisone because she was not 100% sure of the diagnosis. I think this happens quite a bit so patients end up suffering while they wait to see a rheumatologist. I do respect her restraint and because of it I got worse and the diagnosis was more clear.

I learned a new phrase today - "Cat among the pigeons", priceless.

wow !! I am currently trying to read every Hercule Poirot book and short story ! Gonna run right out to the library for this one !

Cat Among the Pigeons is a work of detective fiction by Agatha Christie, first published in the UK by the Collins Crime Club on 2 November 1959,

It features Christie's Belgian detective, Hercule Poirot, who makes a very late appearance in the final third of the novel.

Did I have PMR ? Yes and No! About June 23, I very quickly became very immobile , I was avery active 66 year old and suddenly found myself shuffling around due to hip pain. Getting into a car was an ordeal . My bloods indicated a GRP of 65 and a very raised EST . Suspected by my GP as PMR , I started a course of 20mg Prednisolone. Within two days I was totally pain free . Visited Rheumatologist 3 week’s later more blood tests indicated the inflammation was going down. I began a year long protocol of weaning off the prednisolone month by month. However I developed some circulation problems in the lower limbs .My rheumatologist accclerated the weaning process fearing it might be a reaction to the steroids , I then developed some further limb problems , which accelerated the program further. Quirkiest thing is I never encountered the PMR pain again . So now we trying to diagnose and manage the lower limbs problems most likely caused by the chronic use of steroids . Or another autoimmune disorders may be the cause , yet to be diagnosed. It’s no fun growing old!