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I had all the signs ans symptoms of PMR and GP started me on 15mgs of pred . Had to see liver specialist as liver enzymes crazy and GP worried but he said all signs of inflammation. Had scan and all ok . He was concerned about me as pain still there so gave me 40 mgs . Pain went away but still ill with weight loss , night sweats etc. Saw a rheumo within a week and he felt too young for PMR (57) and wanted me to come off steroids quickly and see what happened . Saw him a week later and he felt I had post viral arthritis ? Now 10 days off steroids feel better in myself but have stiff shoulders and knees in the morning . This is nothing like before as was not able to do anything for myself and pain was out of this world . Feel if had stayed under GP would have been on steroids still with a diagnosis of PMR . Any ideas and would the PMR flared again before now ?

3 Replies

If 15-20mg of pred didn't deal with the pain and stiffness fairly well then there has to be a question as to whether it was really PMR. PMR is just the name for a set of symptoms and they can be caused by various things, including this "reactive arthritis" your rheumy thinks you may have. He is, however, wrong to say that you are "too young to have PMR" at 57 - the BSR guidelines now say 50 and there are patients in their 40s who almost certainly have the PMR we discuss here.

If what you have was PMR then it would almost certainly have flared as soon as you came off the pred - one rheumatology group suggests a "pred sandwich" to see what happens: one week of vit C tablets, one week of 15mg pred and another week of the vit C - the symptoms in PMR improve dramatically during the week of pred but return to the same level when pred is stopped. Other arthritises don't improve in the same way, the symptoms just sort of chug along much the same. Using 40mg rather muddies the water, lots of things will respond to that high a dose. The high dose of pred may well have cleared out much of the post-viral inflammation so you feel a lot better. In PMR the autoimmune cause is on-going and a new batch of the cytokines that cause the inflammation is shed every day in the early morning - and that usually goes on for months and even years, not just a few weeks. One of the criteria for a PMR diagnosis is that the morning stiffness has been there for more than a couple of months. In reactive arthritis it is there and slowly clears up because it is not being replenished daily.


Thank you for your reply . I had the ? diagnosis of PMR within two weeks as I was in so much pain and immobility first thing in the morning and felt so ill . I will take from your reply that it was a more reactive arhritis although had no swelling and pain killers did not touch it . Hopefully things will gradually clear up and get back to my once active self . Thank you


There doesn't have to be obvious swelling and no, painkillers rarely touch it, whether it is PMR or any other sort of inflammatory arthritis.

If it were me I'd give it a bit and see if it does clear up - raised liver enzymes do happen in PMR, but presumably also in other things. It sounds as if your rheumy wasn't convinced and taking away the pred is one way of seeing what is still going on. You are not as bad as before, even though there is still something there and that does suggest it wasn't PMR after all. Not your GP's fault, the differential diagnosis can be very tricky, even rheumies can score a resounding fail! If it all comes back at some point your rheumy will have to think again - but for the moment, if you are feeling reasonably well and continuing to improve. I'd accept that.

I do hope it turns out to have been a reactive arthritis - preferable to PMR any day, it has an end in sight. PMR can go on and on - I've had it for 11 years now. Do let us know when you are back to full health and in the meantime take it easy and avoid stress - doesn't do any of these things any good.


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