PMR? or not PMR? - that is the question.

[Broomser]

Does anyone have any knowledge or experience of alternative conditions that might be / have been misdiagnosed as PMR?. e.g there appears to be some evidence that Lyme disease may present the identical clinical picture as PMR.

[Hidden]

There's a few conditions that present in the similar ways- that's why rheumys test for RA, lupus etc. to exclude other conditions. Lyme disease has been in the news lately, so no doubt there will be lots of people asking for tests. If you feel strongly it could be Lyme - like you had a bite or frequently walked in areas where deer and ticks roam, then ask for tests for the bacteria.

lymediseaseaction.org.uk/ab...

[Hidden]

I am going thru the same question. Is it PMR or Not? I am a male. I first had PMR symptoms at 46. It lasted 6 months and sysmtoms went away slowly on its own without any prednisone. It was very very painful. At 52, same thing... A Rheumatologist recognised my symptoms and put me on 20 mg of prednisone in April this year. It worked beautifully. I went to a different Rheumy last month for a second and he has different approach. He wants me off prednisone ASAP and get me in a flared condition. So, here I am down to 2.5 mg of prednisone with a very aggressive taper and have no problems with PMR pain. Yeah.... Dr. took several blood tests just before my aggressive taper and the results have shown high inflammation markers and high liver markers. Have not consulted with Dr after the results, so not really sure what is going on. However, he did mention Stills Disease, Lupus, Takashaki disease, and RA....

Note my symptoms were exactly PMR symptoms and the sickness was initiated by an injury or surgery both times and was very responsive to prednisone. At a minimum, I know Pred will help me when I get this again... Lymes Disease was not mentioned even though it is very common in my geographical area...

Not sure what it is other than it resembled PMR and was reactive to pred. However, having it twice before 53, being a male, and only lasting 6 months may mean something else. But i am assuming it is PMR as nothing else makes sense.

[suzy1959 in reply to Hidden]

Have you come across Reactive Arthritis? Look it up and see if it describes your experience. I"m pretty sure I had it after having my first child, 31 years ago. It did go eventually, but the pain was very similar to the PMR pains I now get.

[Hidden in reply to suzy1959]

Hey Suzy, not sure about Broomser, but my fingers did resemble sausages they were so badly swolen. But the pain in the shoulders and hips was crippling. The PMR symptoms seem most appropriate for me. Did you have crippling hip and shoulder pain with the Reactive Arthritis? and how many months did the pain last? Nobody has ever mentioned Reactive Arthritis, but it doesn't seem too far out from PMR.

[PMRpro Ambassador in reply to Hidden]

Sausage fingers are often found in spondyloarthropathies - which can also cause symptoms identical to PMR, especially in the early stages. They do also respond to pred but patients then experience problems reducing the dose to low levels. There was a lady on the forums some years ago who was dx'd with PMR. She had some GCA symptoms although they were uncommon ones and he doctor refused to consider it. Referral to Dr Gasgupta resulted in a diagnosis that she had probably had GCA but it was now inactive. Eventually she saw another rheumatologist in the north of England who picked up a comment about the timing of her back pain being earlier in the night than is usual for PMR. Further imaging showed she had ankylosing spondylitis - which responds to higher doses of pred but is far better treated with other medication.

medicalnewstoday.com/articl...

[Hidden in reply to PMRpro]

Holy crap! That sounds familiar. Regardless, to me I would really like to know what I have to prevent another bout if at all possible. However, I doesn’t really what it’s called. As long as I can keep my prednisone if I get that crippled feeling. Thanks Pro! I really hope all is well with you. I feel as though I owe you something for all your incredible insight and support

[PMRpro Ambassador in reply to Hidden]

Being on the right drug helps if that is what it is!!!!

[piglette]

They reckon I understand that nearly forty per cent could be mis-diagnosed for PMR. Vitamin D, Rheumatoid Arthritis, cancer, Lymes disease and probably several other things.

[PMRpro Ambassador]

PMR is a diagnosis of exclusion - all the other potential causes of such symptoms should be excluded and only then PMR taken as the most likely. There is no specific test for PMR - just a building of a clinical picture that suggests it and then looking for a speedy response to a moderate dose of corticosteroids. Lyme is unlikely to respond to pred in the same way as is so typical for most PMR patients. A high dose of pred is not advised - other things would respond to high dose pred and some other things might respnd to 20mg too. Then it is a case of looking at the patient being able to reduce the pred dose - any patient experiencing severe problems with reductions from the starting dose should be investigated further.

Lyme is notoriously difficult to diagnose - but it does really also require the opportunity to become infected.