Have had two private consultations recently with Rheumatologist.
First consultation on 30 Mar and findings were features of a right capsulitus, PIPJ of right finger swollen and elevated inflammatory markers from blood tests taken in late Jan/early Feb.
Possible PMR having developed Polymyalgia features. Given trial of Prednisolone (15mg) & have repeat blood tests at doctors.
Second consultation on 13 April findings were pre treatment CRP reduced from 35 to 8, additional blood parameters normal.40% gradual improvement since starting Prednisolone. Response to steroid are atypical for PMR.
Appeared to have suffered an acute illness at beginning of year that is reflected in elevated CRP, illness probably post viral and current symptoms could be post viral rather than PMR?
Prednisolone reducing to 10mg from 27 Apr & 5mg daily from 25 May.Repeat FBC, ESR & CRP on 21 May and keep a watchful wait until returning to Rheumatologist on 25 May.
It has been a whirlwind last few weeks with much to ponder.
Do I have PMR or a post viral infection? Feeling confused and flummoxed!
Any advice provided would be much appreciated.
Finally I would like to thank this forum as it provides people with so much information on PMR and many other topics.I know far more about PMR than I did only a few weeks ago.
Written by
Countybowler
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"40% gradual improvement since starting Prednisolone. Response to steroid are atypical for PMR"Not if 15mg is not enough for you - the recommendations in the most recent guidelines are for the lowest effective dose in the range 12.5-25mg. There is a big difference between 15 and 20 - even 1mg can make a big difference.
However, there is thought that one form of PMR can be reactive - like there is a form of inflammatory arthritis that is a reaction to an infection and it resolves as the infection goes.
I think you need to be patient and see what happens - and whether the symptoms roar back as the pred dose falls.
The tapering regime you’ve been given obviously means Rheumy has discounted PMR - bit premature methinks. As PMRpro says if 15mg wasn’t high enough you wouldn’t get the results expected... it is a common starting dose, but many need a bit more - especially if you’re a strapping lad!
The acid test will be the reduction come 27th April - has he given you the option to contact him if you have issues - or is done and dusted as far as he’s concerned?
Even if that dose is okay - another 5mg reduction a month later may not be pleasant.
My original Rheumatologist was fairly certain I had a temporary post viral syndrome too but the taper off proved that to not be the case. So that will be evidenced if your pain returns.
It's preferable to know if it's temporary since you won't need long term steroids but the only way to know is to reduce. I hope you can get in touch if things get more painful before you see them again?
It's frustrating but the first thing I learnt quite keenly that where rheumatology is concerned it seems that there are few conditions that there is a test to prove. It's more a balance of evidence and response to medication.
Not like a broken leg for example where it's usually fairly obvious on x-ray. Although I'm sure a few of those sneak through undetected as well!
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