Are PMR symptoms initially intermittent?

[jane1964]

Hello, I am 50 years old I have other autoimmune diseases I saw a rheumatologist last year because I had had aching joints including wrists shoulders and a very bad attack of pain in the ankles.The rheumatologist said I had gout but also found inflammation in the blood raised CRP and ESR.In the last month I have had 3 attacks each involved pain which built up over a few hours worsening in the evening this pain was in ankles knees shoulder and muscles,this pain was very bad and also in the muscles in fact I felt I ached everywhere except for my face,I have never felt so I'll. I felt extremely weak and could hardly move needed help to stand move and dress in fact to do anything!These symptoms lasted about 48 hours,and then I went back to a general slight stiffness and moderate pain.l saw my own G.P. who said this wouldn't be gout.I am seeing the rheumatologist again in September,could this be PMR?, can the symptoms be intermittent?

Thank you.Jane.

[PMRpro Ambassador]

No - that doesn't really sound typically PMR to me. One criterion of diagnosis is that there is morning stiffness that lasts more than an hour - but it also returns any time you sit for any length of time as something called myogelosis (myo- means muscle, -gelosis speaks for itself) so it apparently lasts much of the day. Otherwise though the stiffness tends to improve during the day as you are able to move around a bit - movement definitely helps PMR stiffness. Where there is joint pain it is due to synovitis and tends to be there most of the time.

What you are describing also sounds typical of the early stages of an inflammatory arthritis but which is difficult to say. It could be palindromic rheumatism which typically has attacks that last a few hours or days and then disappears again until the next time (palindromicrheumatism.org/s... is a good description).

When your rheumatologist said it was gout did he do any joint aspirations to confirm his diagnosis? Gout is caused by crystals in the joint which lead to the irritation and pain. True gout is diagnosed by a high uric acid level in your blood and sodium urate crystals forming in the joints. There is another form called psuedo gout where the crystals are calcium pyrophosphate, a different cause, and that is clarified by looking for the different shaped crystals in the joint fluid. Treatment is similar though.

It could be PMR - but there are other more likely answers. PMR is just the name given to the symptoms caused by an underlying illness and it means that something called a "differential diagnosis of exclusion" must be made. You must rule out all the other options first and if they are all discounted you can say it is probably the PMR we talk about here. The pain and stiffness should respond dramatically to 15mg of prednisolone - about 70% improvement within a few days. If it doesn't then another cause should be considered again.

Do let us know how you get on.

[jane1964 in reply to PMRpro]

Thank you for the useful information, my uric acid level was slightly elevated and I am on allopurinol but no crystal aspiration was done.I think I may well have gout it was a reasonable explanation for the ankle symptoms in December but I am sure that there is something else I will have a look at the information on palundromic rheumatism.

Thank you again, I will let you know what the rheumatologist says in September.

[PMRpro Ambassador in reply to jane1964]

Gout is a disease that can affect the whole body so it is important to identify it properly. I thought colchinine was the drug to be used in the acute stage - and an NIH paper says "Long term prophylaxis should be with allopurinol, but this drug should not be started until one month after an acute episode," but even so, the dose of allopurinol is obviously not managing the problem so some form of rethink is needed I would have thought.

Good luck.

[jane1964 in reply to PMRpro]

Yes because my GP doesn't think recent problems are gout, she has left me on the allopurinol until I see the rheumatologist in September I had a blood test last week to check the uric acid level and SET and CRP again, they have been elevated now for nearly a year.I am going to press the rheumatologist for a better answer next time as the last month's attacks are so bad and I really do not want to be like that again if this can be treated.Jane