The importance of seeing a rheumatologist

There are reasons specialists are needed for rheumatology conditions. Diagnosing PMR isn't that easy to begin with. Starting someone on long term prednisone and telling them to taper off slowly also gets complicated.

I'm a dilemma for a rheumatologist because of multiple autoimmune conditions and decades of prednisone use. I remember being diagnosed with seronegative inflammatory arthritis in my early 30's. There are multiple types of inflammatory arthritis and the symptoms are just like PMR except for subtle differences.
https://www.hss.edu/health-library/conditions-and-treatments/list/inflammatory-arthritis
Most types of inflammatory arthritis respond to prednisone just like PMR. In fact, my case of reactive arthritis responded to prednisone better than PMR ever did. Treating inflammatory arthritis with long term prednisone might be considered malpractice. Prednisone is a highly effective, rapid-acting anti-inflammatory that works across a broad spectrum of conditions but it isn't appropriate for many conditions.

A rheumatologist can struggle differentiating inflammatory arthritis and PMR based solely on a patient's description of symptoms. There are lab tests and imaging scans along with a hands-on physical exam. I'm amazed by people on the internet who tell other people how to manage PMR. They do this sight unseen based on a little blurb that someone posts on the internet.

I remember when I was diagnosed with PMR in addition to inflammatory arthritis. I didn't know it was possible to have more than one autoimmune condition. I only knew prednisone rapidly relieved my pain. At the time I was diagnosed with PMR there were 3 rheumatologists involved. If it wasn't for a rheumatologist and an endocrinologist, I would never have tapered off prednisone.

There is a shortage of Rheumatologists. Two of my most caring and fine clinicians have been female physicians. That is the trend -it attracts bright
women.

Can a PCP prescribe biologics like Kevzara or Actemra?

Yes.

However, insurance assistance may require Prior Authorization coordination with a specialist (rheumatologist) being involved in diagnosis and even failure of other drug treatments.

The importance of seeing a rheumatologist may be financial and/or if prednisone causes health problems for you.

Technically a PCP can prescribe a biologic but I don't think too many PCPs do. They usually leave that decision to a specialist. I asked my PCP a question about Actemra one time and he simply said Actemra was "out of his league" and directed me to my rheumatologist.

I had so many autoimmune problems and Prednisone side effects. I was never sure who I needed to report my symptoms to and ask questions about my treatment. My PCP was indispensable as a gatekeeper and made sure I saw the right doctor. My PCP had enough to worry about with my general health and well being. My PCP managed my Prednisone prescriptions and side effects. I kept him very busy with those problems and concerns.

Your PCP was naughty at a minimum. PMR is a default diagnosis, meaning if it is not something known and you have certain symptoms they tag you with PMR. Since you did not have the tests to eliminate things that look and feel like PMR but have tests and treatment protocols to manage them then you were misdiagnosed. Be glad your PCP retired. You should have insisted on a referral and been prepared to change PCP if need be. Next time do not let a doctor do this to you. Stand firm that you want a specialist to weight in. BTW, misdiagnosis happen every day - and possibly by every doctor. Often we don't know it happened because our body heals itself.

Specialists are called specialists for a reason. PMR is a difficult proposition for doctors too. Sounds like you had an old school doctor who didn't want to admit that they don't know everything. Sometimes we need to take control over our healthcare and find a doctor who's willing to listen, discuss and know their limitations. A primary care doctor should be the manager of our healthcare and indirectly coordinate with the specialists that we need, and we need to keep them in the loop so they can.

Here in Canada one is lucky to have a primary care physician. Mine is now closing his practice, that’s why I got a referral to the rheumatologist…someone to monitor my situation. I do not know when I might get a new PCP…it could be many months?

I had been healthy so long, that my gp had retired and I hadn't bothered to look for a new one. So when PMR hit me, I had to scramble and ended up with a new doc, whose daddy owned the practice. She prescribed meloxicam (useless) and PT (also useless). I ended up changing doctors for a different reason (totally unresponsive office). I never actually saw the new doc, but his PA looked at my hands and referred me to a rheumatologist. If I hadn't had obvious osteoarthritis, it might have taken even longer than 4 months. The rheumy diagnosed me in 5 minutes.

@54pontiac
Good to hear.

@54pontiac
Good PA working with your new PCP. I think you’re in good hands now.

When I moved here, 30 years ago, I interviewed a doctor to be my PCP. I told him I was looking for a doc younger than me but with a few years of experience, not fresh out of school. The reason? I told him it was an interview, because I didn’t want a doc older than me who might retire or worse die when I’m an old man. (That had just happened to my 70ish mother.) And, I said, I wanted to see him to make sure he looked healthy before I chose him for my PCP.
He laughed his aaa off and said that was the first time he’d heard that. That was 25+ years ago.
I recently, after PMR, told him he is my “Chief” and the Specialists are his “Cabinet.”
I make him aware of everything.
He’s ok with that.

Oh, my mom, she just celebrated her 93rd.

I wish the best for you with your new PCP.