PMR or something akin?--- The saga continues

[violetsnowdrop]

My visit to a Gp at the practice on Monday left me bemused for, although I was given antibiotics to fight a cellulitis attack, the Doctor (who is very senior- due to retire soon!) then asked if I was off Prednisolone yet which he followed up with the statement " You should have been off prednisolone by now--you really need to try harder!" And they wonder why I booked a sit & wait appointment with a different GP !?!?.

I have just returned from a return visit to a GP (fortunately not the same one) with the following action having been taken:- Shoulder joints (x-rayed 21/03/14): left is showing as normal (the more painful one); right has wear & tear with some calcification (not unsurprising as I was a Shot and Discus specialist and counted ten-pin bowling amongst my hobbies). GP has now sent review to rheumatologist to hasten an appointment to clarify whether I have PMR recurrence or not and,if so, by how much pred dose has to rise.

Symptoms presented were:-

1.Shoulder pain/stiffness –not confined to post rest periods and other arm joints are also affected. Lifting arms above shoulder height is quite painful WHEN it can be achieved; wrists not loadbearing when palm upwards; fingers are sometimes swollen (painful to make a fist) and sometimes just feel swollen. When hand is turned outwards discomfort on inside of elbow joint and when turned inwards/ arm flexed then discomfort on outside of joint. Levels of discomfort increased when down to 5mg Pred and have continued unabated despite increase to 10mg Pred. Intermittent pains in groin; rear of thigh and down outside of knees. Occasional ‘shooting pains’ on hips.

2.Continued muscle weakness. Lower Back Pain when standing for more than 10 mins which eases when sitting/resting.

3.Consequent lack of mobility-- unable to walk more than 40 metres without resting (with walking stick and in small steps). Climbing stairs is easier/more comfortable on all fours..

4.Frequent foot, calf & thigh cramps (probably linked to leg lymphedema/ lack of sustained activity and exacerbated by the water retentive properties of prednisolone).

5.Suffering from disrupted sleep patterns: prior to taking prednisolone I slept uninterrupted for about 6 hours daily but I now sleep for a maximum of 3-4 hours; feeling so fatigued I often have to sleep for 2-3 hours during the day.

6.Increased sensitivity to noise/light with subsequent irritability.

7.Insulin dosages increased to keep blood sugars stable (in consultation with diabetes nurse)-4 times daily.

[PMRpro Ambassador]

Are your GPs totally out of touch? "Think positively and your PMR will go away!" - er, no!

Was this morning's unable to try the standard suggestion of 5mg more than the dose you have pain with - back to 15mg in your case I suppose - or even, horror of horrors, PICK UP THE PHONE? If it helps it's most likely to be PMR, reduce VERY slowly once the pain is under control. If it doesn't, nothing lost, go back where you were after a week and consider something else.

Do you have access to an osteopath/chiropractor/physio or (even better I think) a Bowen therapist? The low back pain is not typical of plain PMR but it is often seen alongside PMR and is due to spasmed muscles in the lower back - often due to myofascial pain syndrome - which pinch the sciatic nerve and cause referred pain in the back and down the legs. And the same thing can happen in the shoulders causing shoulder and neck pain and even down to the elbow and wrist. Once mine was sorted out by a physio and cortisone injections I've gone from strength to strength and am down to 5mg. But the evidence is it needs targeted treatment of the trigger spots of knotted muscle.

[violetsnowdrop]

Hi PMRpro

It was almost as if he was 'passing the buck' to the rheumy. If I think back it was my suggestion to increase pred to 10mg last time; on this occasion he's looking for the rheumy to decide. I have seen this type of indecision becoming more prevalent in our litigation-mad society ( If I dither someone else will make this decision for me and then I can't be wrong). Ironic really, because it was one of his Associate partners who diagnosed PMR & GCA originally!! Picking up the phone would have taken him over the 10 min MAX consulting time (God forbid!). However, in his favour he did at least read my list of symptoms (I had typed them out) and incorporate it into rheumy referral.

I have, off my own back, increased pred to 15mg yesterday and already can feel (or not, in this case) the benefits. Thank you again for your advice