Appointment with rheumatologist

[Janann25]

I was diagnosed with PMR about two months ago and my symptoms were relieved immediately. On the doctor's advice I started a reduction of 2.5mg with disastrous results so, following the advice of the lovely people on here, I reduced by only 1mg. Unfortunately this was still not enough so I went back up to my 15mg. Initially this helped but about 10 days ago, I started experiencing dizziness, really loud ringing in one ear and pressure head aches. Of course, having to start antibiotics for an infection under a crowned tooth hasn't helped!! Then, over this last weekend I also started to feel very tired so decided I should get investigated. I managed to see a doctor yesterday morning. I already had a bone scan scheduled for yesterday afternoon so at least I knew that that would be checked. The doctor immediately arranged blood tests - these were taken the same morning - and is make no an urgent referral to a rheumatologist. So, my question is, what is likely to happen at this appointment - is it just a chat, are more tests done, is new treatment suggested? I would be very grateful if someone who has experienced this could give me some advice. Thank you again.

Jan

[PMRpro Ambassador]

It sounds as if your doctor is suspecting that your PMR has turned out to be a forerunner of GCA. Unless they have access to ultrasound of the temporal artery there are unlikely to be more tests done at the time of your rheumy appointment - though they may take blood (again) and possibly do an x-ray though I doubt it unless they suspect anything other than GCA.

The normal approach with suspected GCA would be to increase your pred dose considerably. There is a new drug, tocilizumab, which has been found to work well in GCA but it is not yet approved in the UK although it is being used in individual cases I think. You still start on an appropriate dose of pred for GCA but the tcz allows a much faster reduction.

In the meantime, if you have ANY visual symptoms at all please get in contact with this doctor immediately - and if you can't, don't wait but go to A&E and tell them what is going on. Don't be fobbed off, if they aren't helpful ask to see the consultant and be insistent.

What sort of bone scan? A dexascan or another sort?

[Janann25 in reply to PMRpro]

First of all, thank you once again for your very prompt reply. My scan was a Dexa Scan. I didn't know there were various types - what are the differences?

Jan

[HeronNS in reply to Janann25]

A DXA scan checks for bone density only. Other scans would check for disease.

[Janann25 in reply to HeronNS]

Thank you.

Jan

[PMRpro Ambassador in reply to Janann25]

You can also have bone scans where you are injected with a substance that shows up any areas of damage - some patients get them mixed up.