PMR diagnosis help

[Caro12line]

Hi... I have GCA and have very little knowledge of PMR. However my sister in law is having all the symptoms I read here and I suspect she has it. Her GP has done blood tests (not sure for what and no idea of results). My SIL is in real pain and finding just getting out of bed near impossible. She went back to GP today and GP has upped her Napatiplin(painkiller?) and referred her to a pain clinic for next week. The GP said “ ask at the pain clinic if it could be PMR, I think that’s what it is but I can’t say”. This I find outrageous! Surely if the GP suspect PMR she should be referring her to a Rheumatologist.... not a pain clinic... thoughts and advice please. Thanks

[SheffieldJane]

You may well be right. The blood tests look for inflammation levels ( which can be caused by all kinds of things). 20% of people with PMR have normal test results. Symptoms rule where PMR is concerned and above all a rapid positive response to Prednisalone. Could she ask her doctor for a one week trial of Pred. at say 15 mgs.? She would soon know.

[Telian]

Lets hope the pain clinic aren't as silly as the GP. Her GP could have given her steroids surely. What a waste of time. No harm done if it's not PMR she can stop the steroids quite quickly when used short term. If it is then she will have almost instant relief. QED!

[polymy]

It sounds like PMR to me too. Many GPs deal with PMR at surgery level if it responds to prednisolone so it wouldn’t be automatic that your SIL sees a rheumatologist. GP is very remiss in not trying pred for her symptoms. She should ask for a trial of the steroid.

[Caro12line]

Thank you for your replies. A trial of Pred does look like the best way forward. I’ll get her to ask her GP. Many thanks x

[PMRpro Ambassador]

Totally agree - and I'd be asking why they are occupying a position that requires them to be able to make independent diagnoses when they are obviously not confident to make them. They can't even make the right decision as to where is most appropriate to refer her on. They should be asking their fellow GPs first.

And maybe read this:

rcpe.ac.uk/sites/default/fi...

If the painkiller isn't working then there is little point taking it. A week of pred would add some information - does it or doesn't it work? And in the meantime the most appropriate refarral is NOT to the Pain Clinic but to a rheumatologist - because the most likely alternative options are autoimmune disorders with a polymyalgic presentation.

Time for a different GP - I was stupid enough to continue with my usual guy who was clueless. Had I toured the practice I would have met the lady who DID know about PMR - and taught the other one to use google to get suggestions with regard to a set of symptoms!

[Caro12line in reply to PMRpro]

Thanks PMRpro... I’ll keep you updated x

[daworm]

my family Dr knows about as much as I do about PMR, in fact I told him that I think its PMR not just bursitis and brought him a read out of info from the web...luckily he takes info and doesn't mind that kind of thing...some would never allow a patient to do that, I know I had a doc who was "too smart" for that stuff...so perhaps its time for a different GP...the patient is supposed to be the boss, rarely works that way...