My husband was diagnosed with PMR in September 2016, and GCA in December 2016. He has gradually decreased his steroids to 10mg but despite several attempts at slowly tapering, seems unable to get below that. However for the last year his main problem has been chest pain. At present it is so bad that he can hardly breathe first thing in the morning, and it wears over gradually through the day, until it has gone by teatime. The Rheumatologist has requested numerous scans, X-rays etc over the last year which have not revealed any cause of this pain, and he seems to be thinking that perhaps this chest pain is not related to the PMR. Do many people on here suffer with this chest pain as part of their PMR? At present his CRP is slightly raised, and ESR normal. This pain is really getting him down, it’s awful seeing him suffer.
PMR and chest pain: My husband was diagnosed with... - PMRGCAuk
PMR and chest pain
Hi. I too suffer with similar pain first thing, although it’s not too severe I do dread having a sneeze come on first thing in the morning as if I do it feels like my sternum will break! The pain is awful. By the afternoon I feel fine and a sneeze is no problem.Tell him to read about costochondritis it’s inflammation of the joints that join your sternum to your ribs so likely part of PMR.
I also have synovitis in my sterno clavicle joint which is a similar inflammation. My doctor did various tests and X-rays to come to that diagnosis. He lets me vary my dose of prednisolone if it gets bad although it’s fine at the moment on 4mg.
Hope that helps 😊
Edit: correcting spelling
If anyone wants to look it up, it is sternoclavicular joint
Thanks PMRpro, that’s correct. I didn’t notice predictive text changed my post to stereo 🙄
I hate predictive text! It does have some funny effects sometimes! Stereo seems OK - there are 2 of them, one on either side 
Is your pain right in the centre of the chest too? It’s odd the Consultant didn’t seem to think it was part of the PMR. He said he was considering referring him to the Chest Physicians, saying nothing was showing on any scans(CT and MRI). But his CRP is still slightly raised so there must be something going on. The Rheumatologist also said try going down to 9mg from 10mg. So he did this a fortnight ago and has been worse since. Thanks for any help and advice.
Yes it is right in the centre but I’d let the consultant refer him, it’s best to get professional advice to rule out other things.
Is the pain in particular points and can he press on the worst bits ? It might be costochondritis. I had this big time after chemo and radio therapy years ago. I found a soft mattress to be awful because as I sank into it my chest was folding in and I think it put stress on the attachment points of the ribs to the chest bone. Do any normal pain killers help?
I have such a job persuading him to take any painkillers! They don’t appear to make any difference anyway. His pain is right in the centre of the chest - is this where yours was? Thanks
Well tell him to try painkillers because it is a diagnostic tool! 🙂
Re pain location - if the chest bone is like a breast plate, the sore bits tend to be round the edges and are jolly sore if poked. The soreness can feel like it is all over though if it’s all kicking off. I also got it a bit round the back where the ribs join on there but not as badly.
If it is deep in his chest
Well I have persuaded him to take painkillers, (after reading him your reply - obviously that had more effect than my advice!) and he feels they have helped a little, though the pain is still there and now lasts all day.
The pain is definitely just in the centre of the chest
I do think he needs medical opinion. It could be something like trouble with the oesophagus or stomach or a problem with the aorta or heart; an ultrasound can show things up like aneurysms. If it is something concerning he needs help now not when things go ballistic. Tell him from me, that not knowing what it is doesn’t make it go away and he’ll feel like a right banana if he’s facing a close call that could have been avoided! Besides it is worsening, he’s put up with it up to now, so he’s clearly not fussing or being a nuisance.
Has he had a specialist ultrasound scan for GCA? My Large Vessel Vasculitis/Giant Cell Arteritis was diagnosed that way. It wasn’t picked up by MRI/CT type scans prior to this. Has his Aorta function been scanned? Certainly cardiac tests should all be done. The cause may be muscular but clearly it is best to eliminate anything serious. Where in his chest is the pain?
I asked the Consultant if it could be LVV and he said they had checked for that on his MRI, CT scans. He didn’t mention ultrasound and my husband hasn’t had one. The worst pain is right in the centre of his chest and radiates out. He has had this pain over 12 months but worse at present.
I felt lucky that the Ultrasound Scan showed the abnormalities in the arteries of my left armpit. No other test showed anything.
Yes. Had X-rays, scans etc. Also tingling feeling in back of chest left side. Wears off but always comes back
What about a PET/CT scan? Seems to be good way to identify vasculitis.
Amazingly my wife, who had GCA and now ?PMR?, has bad chest pains and having seen a new rheumatologist (as last one diagnosed ME !!!! ) has a scan booked just three weeks later. NHS we love you!!!!
Gosh that was speedy! My husband has had several CT scans and they have just said no abnormalities detected.
Im a 60 yr old make -diagnosed with PMR 2 months ago- all the classic signs and blood test results. 15mg of Pred helped take away low back and hip pain but my chest pain in the same areas you describe and the neck is still stiff and sore. My clavicle pain where it meets my shoulder girdle is still bad.SO my Rheumatologist wants to Cat scan those in April but in the meantime this is really hard on me. If I cough its painful all the time. The thing with PMR you never get a break from the pain and soreness and stiffness and limitations-- its always there- like other health issues sometimes it subsides but I fond the level of pain is always there regardless pretty well what you do...Any help or thoughts by anyone is appreciated! Nick
I had the same problem and I was diagnosed with costochondritis. My comes and goes. I had pain everyday for about four months. Because I have heart issues and AS I thought it was that. Hope he is feeling better.
Hi- Im having the same issue-- tapering and the chest pain in both sides is unbearable and if I take a littke deeper breath - I have muscle pains in the chest..,I have alot of pain in my shoulder clavicles and neck are is very stiff-- upper back is sore -- lower back to too bad,... now the Dr is think its not PMR - but I have all the classic signs on the blood work etc. I was a very active healthy 60 year old a few months back but now Im in a bad way and cant do any activity. Now the DR is prescribing Naproxen and doing chest xrays and MRI scan- so the fact that nothing helps ( im on a Paleo diet and I take supplements too) Nick
There are no classic signs in bloodwork - just signs of inflammation but they are non-specific, they can be due to all sorts of things. What dose are you on? At what dose did these pains start? Did you get relief from your symptoms at the starting dose?
Thank you for your follow up. I started on 15mg 2 months ago and then he started tapering--Im at 5 mg now.. so when I started it helped my lower body parts by 50% - so that was not too bad- my upper body had improved about 25% when I started on 15 mg- as I was tapering my upper body has now returned 100% painful as when this all started. So my lower parts ( hips and low back) now the pain has returned as I have tapered down to 5mg. SO I thought well why taper when the pain was coming back -- but the dr wants to be careful and get off pred. and is convinced this is NOT PMR-- but in my books its PMR-- does anyone know other conditions that mimic PMR??
Your early relief on a low-moderate dose of pred and the return of all the pain as you suffered through a rapid taper are indeed indicative of PMR. It also sounds like you never were given the chance to get the imflammation properly under control at the very beginning. Why is your dr so sure it's not PMR? If not PMR what is it then? And why isn't he treating it?
He's dropped you from 15 to 5mg in TWO months? No wonder you are in a mess. The median time to get to 5mg for some time is 18 months. He doesn't have a clue how to manage PMR.
rcpe.ac.uk/journal/issue/jo...
is an outline of a taper that the rheumatologists at Bristol used that reduces the rate of relapses a lot. It keeps you at 15mg for 6 weeks, 12.5mg for 6 weeks and then 10mg for a year - which is when most relapses on other suggested tapers arise.
There are other things that can cause PMR-type symptoms - but few of them will respond to 15mg pred as well as PMR does. You can't have been on 15mg for long, the current recommendations for the management of PMR suggest a starting dose between 12.5 and 25mg per day - some people need a bit more than others and a bit longer. An overall improvement of 70% fairly quickly is what they look for but that does require you are on enough and not all the pain goes quickly. 15mg gave me a minor miracle in 6 hours but it was a 6 week taper and stop - within 6 hours of missing the first 5mg dose I was worse than before.
It is fair enough to question whether it is the PMR we talk about her - but it is unreasonable to say it isn;t PMR without good reason. What does he suggest it is?
Thanks that is so helpful!! I really appreciate and it gives me something I can try to take that direction.... he said some other rheamatic condition,... so nothing for sure yet- he put me on Naproxen now for 8 days and that has not made a dent.... and Im getting an MRI on April5th- of the chest when I told about the clavicles and the chest he said I need an MRI - which I think is going to be a useless to do.. ITs painful todo basics- shower my hair, tie my shoes, turning in bed, putting on my jacket etc. Walking is OK on legs- but I have not been able to relax my shoulders downward fully and comfortable- since this hit a few months ago.
That sounds as if he thinks it may be ankylosing spondylitis or another spondyloarthropathy - they often respond to Naproxen so the non-response is a factor for PMR. The MRI will probably be to look for the changes in the spine and/or sacroiliac joints,
Try heat on your shoulders - I know that feeling, I can feel my shoulders rising up towards my ears as I walk!! And I had 5 years undiagnosed - I will never forget that pain. One rheumy wanted mine to be a spondyloarthropathy - he wouldn't give up even when all his imaging showed it wasn't. They get an idea in their head and like a dog with a bone they won't let go.
Where are you?
I have GCA and around the time I was diagnosed I was suffering from extreme pain in the center of my chest. I found out that I have costochondritis which is inflammation of cartilage in the ribcage. I have some heart issues, so a lot of tests were done and my problem was not my heart if that makes any sense.
Just to update this, over a year later! The chest pain continued, and finally my husband recently got a PET scan, as Tonylynn had suggested. That was quite an ordeal as he had to drop from 9mg to 3mg of Prednisolone for a week before (the Radiologist’s rules). The result of this is that he has just been diagnosed with SAPHO Syndrome. They are going to try him with a DMARD, but in the meantime carry on with 15mg of Prednisolone as every time he comes below this dose he has a flare. It is now 5 years since he started with PMR and then GCA.
Does anyone on here know anything about SAPHO, or been diagnosed with it? Not much information on the internet!
Many thanks
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