A few weeks ago I went to my surgery and saw a locum who diagnosed Sinusitis and as she gave me the prescription I just asked if this would get rid of the painful shoulders and arms I have had for a few weeks (I had been putting it down to "old age" - I am 57 years old) she then looked at me and asked me to raise my arms which I could do with some difficulty -she asked if I had pain elsewhere - I told her that I often get pain in my hips and buttocks really bad in the morning but as the days wears on gets slightly better then at night time returns - she suggested I may have Polymyalgia but sent me away with antibiotics to help the sinusitis and to come back if the pain did not subside
5 days later I saw another locum and she dismissed PMR straightaway instead thinking I had cervical neck pain as I often had pins and needles in my hands- she was not interested in the pain I had in my hips, buttocks - she took blood and made an appointment for a neck xray - I really do not have pain in my neck ! The bloods came back with borderline increased ESR and CPR results but the pain is as bad as ever, paracetamol does nothing(cant take ibuprofen), I am tired as I do not sleep as I waken up with painful shoulders and turning over in bed is a major manoeuvre. My neck xray is next week but I have an appointment tomorrow with said locum before she leaves the practice - what should I be asking her ? I just know I cant continue much longer with this constant pain.
Written by
Auldcoo
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I'm not a medic, but from experience, your description of your symptoms sounds like absolute classic PMR (Polymyalgia Rheumatica). Just a couple of comments:
I think your first locum is on the case, 57 isn't 'old age' (!) and it's not uncommon for people to get PMR at this age (I did..). Your Sinusitis might (and I stress might) have triggered your immune system to go into 'overdrive', where it over-reacts. Viruses and Infections are sometimes linked with PMR onset. As for bloods, ESR and CRP don't necessarily correlate with PMR, i.e. you can have low-ish readings for both and still have PMR (as did I).
The usual route for a formal diagnosis of PMR is an appointment with / examination by a Rheumatologist, although a savvy GP might put you on Prednisolone medication (the gold standard treatment) to test the PMR theory in the meantime. If you have almost instant (i.e. after a few hours) relief from most of the pain, stiffness, etc, this is usually a reliable indicator that PMR is the culprit. Also, Paracetomol etc. don't even touch PMR symptoms, so this is another pointer to you having PMR.
Yes, the initial pain, stiffness and fatigue (before treatment) is awful - literally crippling for many. Personally, I would either try to get in front of your original locum urgently with the information about PMR symptoms and treatment available on this forum and PMRGCAuk, or press the second one to review your symptoms / treatment based on same. And, in either case, ask for an urgent referral to a Rheumy asap.
No doubt the forum's 'Aunties' (trusted experts) will be along shortly with their views, so sit tight and you will get tons of support and reliable advice here. Unfortunately, some GPs aren't very well educated about PMR - as you'll discover from other posts and threads here.
Either way, don't waste any time and suffer un-necessarily - untreated PMR can wreak havoc with 'normal' life at best. And there is also a potential (albeit small) risk of GCA (Giant Cell / Temporal Arteritis) with these types of symptoms, which is far more serious in that it can seriously and irrevocably damage your eyesight...
Not wishing to alarm you (on the GCA side of things), but I hope this helps. Please keep us posted.
By all means ask for referral to Rheumatologist, but if she not convinced you have PMR, she may not agree.
You could suggest that a trial of steroids for a week may prove it either way - painkillers do nothing for PMR. If the steroids don't work then it's not PMR, and only being on them for a short period is not a problem.
Don't be over-ruled because your blood markers are not sky high, many patients aren't - in PMR the symptoms are the key!
You might also like to highlight the fact that sometimes if left untreated PMR can develop into GCA, and that can cause sight loss. And you are absolutely sure she wouldn't want that to happen, would she?
Unfortunately you are not the first, and I doubt you'll be the last patient having difficulty getting a diagnosis of PMR. You have to be persistent in this game!
Can you try and get a trial of say a week on steroids? This should give a feel if PMR is the problem and if it isn't you just stop taking the tablets. You may need to push.
Thank you all for your replies- I saw locum on Friday she still thinks I have cervical neck pain - she is unwilling to give me steroids because of the complications with my diabetes medication and blood sugar issues- she also said as she was leaving the surgery she did not want to start me on steroids and my ow n gp take the decision . she started
me on 20mgs amitriptyline at night till I get an appointment with my own gp- Nov 6th I am going to take each day as it comes . THanks for all your advice so perhaps I may be the lucky one who does not have PMR
I have my appointment with my gp tomorrow - neck X-ray was clear- still in pain stopping the statin has made no difference-just taking co-codamols, stopped amitriptyline but within 3 days sleep was interrupted again leading to greater fatigue so restarted although they make me quite fuzzy in mornings. I honestly believe I am not one bit better since going to see locum nearly 2 months ago - what questions should I be asking tomorrow ? I just want this pain to go it is beginning to get me down
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