PMR??? Correct diagnosis??

[Nanapat12]

My GP has diagnosed me with PMR but I’m not convinced. Severe stiffness for 2 days but only minor aches and pains before after that. Residual issues with burning in legs and hands which pred 15mg (day 4) having no effect. Any advice/thoughts welcome

[Hidden]

Sounds a little strange, and the fact that 15 mg didn't help at all would make me suspicious that it was something else. Sometimes 15 isn't enough to make a big impact but I would think it should have made some difference in your pain. Sounds like doc needs to be doing more testing for other culprits causing your symptoms.

[PMRpro Ambassador]

15mg is often not enough or takes a week or so to work. Other than the burning - has it achieved anything at all? The most recent guidelines say "the lowest effective dose in the range 12.5-25mg/day". You need enough to clear things out before you can identify the lower longerterm dose.

PMR does oten happen overnight - with little heralding of its advent...

[Nanapat12 in reply to PMRpro]

Thanks for this

Have had less stiffness in hands since starting pred but that was resolving slowly after initial flare up. That said I’ve had a busy morning and now feeling rubbish with stiffness in shoulders again (not as bad but building😩)

Inflammatory markers were raised and examinations by two different GPs consistent with diagnosis. Is the burning sensation ‘normal’?

I guess I just want to be as certain as possible before starting on long term pred that diagnosis is the right one.

Have read some of the posts on this site and think I’d feel more convinced by your experience and thoughts rather than GP simply following an algorithm

[PMRpro Ambassador in reply to Nanapat12]

" I’ve had a busy morning"

No, no - that's not allowed! The pred just manages the inflammation, the rest is up to you! Your muscles remain intolerant of acute exercise as the actual disease process isn't affected at all by the pred and is still attacking the tissues and damaging them. You have to pace and, for a while at least, avoid the things that aggravate the pain and stiffness.

It isn't forever, there is very little I can't do now (lots I DON'T do, but that isn't the same). But for the moment - rest and be a poorly person (at least a little bit!). It's a lot like having flu as far as your body is concerned - it hurts! Give your body a chance to heal - then reassess.

[Hidden]

Hi nanapat

I definitely had burning sensation in thighs and upper arms. I still do if I overdo it. As others have said sometimes it takes longer and a slightly higher dose to help significantly. See what happens in next couple of weeks and continue to get Dr to explore possibilities. It's possible to have osteoarthritis and pmr so maybe there's a flare if that. Good luck

[Nanapat12]

Thanks for your very wise comments - have certainly helped me

So pleased I’ve found this site getting a real prospective from people that really know what their talking about

Many thanks

[Grants148]

I hope you will soon feel much better,it could be that you need a higher dose of preds to start with,also you must pace yourself and not overdo things.Please let us know how you get on.

[Nanapat12 in reply to Grants148]

Well I’m back to Drs tomorrow but having read lots on this site am still unclear if it’s PMR or not

Started over 2 days severe stiffness and pain in neck and shoulders but starting in afternoon and got worse through evening not mornings as I have read. All joints then decided to join in with burning and tingling sensation on feet legs and hands. GP prescribed naproxen (no help) and bloods. Raised inflammatory markers so gave diagnosis of PMR and prescribed pred 15mg. Major stiffness/pain hasn’t reappeared but still stiff in shoulders each morning or if I do too much. Burning/tingling in mornings (minimal today as took pred when I woke 3:30as advised in your posts) and again if I get carried away feeling well.

Not sure what plan should be and not convinced about GP - your thoughts oh wise ones

[PMRpro Ambassador in reply to Nanapat12]

If they can't find anything else to blame, PMR would seem a reasonable conclusion and a basis to work on. The morning stiffness is normal enough until the pred works - and your muscles remain intolerant of acute exercise as the actual cause of the symptoms is still there chugging away in the background and attacking the body.

Why aren't you convinced about the GP?

[piglette in reply to Nanapat12]

Did you have the miraculous improvement to your symptoms on taking pred? In my case it was from intense pain to the point where I could live again.

[Nanapat12 in reply to piglette]

No unfortunately no miraculous improvements with pred. Intense pain had already subsided by time bloods done and pred prescribed. Left with burning sensation in arms/ legs in morning with minimal stiffness in shoulders. Just finished work today and can feel shoulders starting to stiffen and burning in muscle

I guess I just want reassurance that no other possible diagnosis before going down long term pred route

As for not being convinced re GP he seems fixated on NICE guidelines (which is good) but not wanting to even explore differential diagnosis

[PMRpro Ambassador in reply to Nanapat12]

"he seems fixated on NICE guidelines (which is good) but not wanting to even explore differential diagnosis"

Then he's a poor doctor - and probably ignoring other good practice guidelines. PMR is a diagnosis of exclusion - you exclude the differential diagnosis options until all that is left is PMR. And there are quite a few. Have you access to other GPs with more enquiring minds?

emedicine.medscape.com/arti...

uptodate.com/contents/clini...

[Nanapat12 in reply to PMRpro]

Thanks for this - feeling a bit more informed. Will see how he addresses things tomorrow and if still not happy may wait to see another Dr in the practice who hasn’t seemed so quick to draw conclusions in the past

[Nanapat12]

I take it all back!! Felt GP was really listening to me today Together we agreed as pred not really making any difference and symptoms not ‘typical’ to stop- watch and wait whilst he made Rheum referral.

Feel a bit down that I’m no near to solving this (I’m a very impatient patient) but happier that I will (fingers crossed) come out with the correct diagnosis/treatment

Thanks for all you invaluable information and advice

[PMRpro Ambassador in reply to Nanapat12]

Has he tried a higher dose FIRST? Up to 25mg is a recommended starting dose - and it can make a big difference.