PMR/GCA Solitary Lung Nodule

[Ladyhillingdon]

I have a diagnosis of Atypical PMR symptoms started December 2022

Consistent throughout past 9months since symptoms began has been a chest wall pain mostly at shoulder blade level. I was given a diagnosis of PMR after about 3months as it being Atypical because the inflammatory markers were not raised.

The pain continued to bother me even when started on Prednisolone. I had a CTscan with contrast dye and that revealed A solitary Lung Nodule in left lung large enough to be classed as a mass( it is the size of a pencil) .

Standard advice for lung nodules if found , and they are above a certain size is to repeat CT in 3 months to look for changes. It is six weeks since first scan.

I have a few questions - Has anyone else been diagnosed with a lung nodule with PMR /GCA?

I had enough difficulty getting my GP and then a Rheumatologist to believe I even had PMR.

I am not showing any other symptoms of GCA at this time. I was discharged by the Rheumatologist back to the care of my GP.

I am worried I have an occult form of GCA.

Any insights would be welcome.

There are references to lung nodules and GCA on Pubmed

[PMRpro Ambassador]

What have they said about the nodule? Do they think it is benign or is there a possibilty it could be nasty?

You will have probably found papers like this online

ncbi.nlm.nih.gov/pmc/articl...

It is not quite clear to me why your concern is about GCA? As you see from the paper I have linked, PMR is not untypical of certain cancers and that is something that should always be ruled out before the diagnosis of PMR is settled upon. If you are showing symptoms of PMR but none of GCA, then there is no real reason to suspect GCA and there is, at this stage, no way of diagnosing an occult form of GCA. I suppose stopping the pred and carrying out a PET-CT might provide more information but there isn't anything else I know of.

[Ladyhillingdon in reply to PMRpro]

Thank you for your reply

Hopefully not a sinister lung nodule? They won’t really know until they do a follow up CT to see if there are changes.

, I have gone down the route that nodules occur in RA and then I discovered also in GCA.

Nodules are found in a third of patients having a CT of lungs without symptoms , my concern is that I have pain with it and a cough. I am trying not to worry but inevitably I am.

My GP has just written to the consultant radiologist to clarify the nodule size

My GP is on holiday at the moment so things are on hold and giving me more time to worry.

ARTICLE

067. PULMONARY INVOLVEMENT IN GIANT CELL ARTERITIS MIMIC

Mohammad Bardi, Andreas Diamantopoulos, Viktoria Holt

[PMRpro Ambassador in reply to Ladyhillingdon]

ncbi.nlm.nih.gov/pmc/articl...

is of the opinion that "Pulmonary involvement related to large-vessel vasculitides (Takayasu arteritis, giant-cell arteritis) and medium-sized-vessel vasculitides (polyarteritis nodosa and Kawasaki disease) is rare."

Now that isn't me suggesting it doesn't happen - but it is unlikely there is a link. GCA itself is a rare disease in itself. I'm sure that once they do the second CT and come to a conclusion they won't just dismiss them.

[Sophiestree]

They found a nodule on my lung pre diagnosis of LVV.. I have a yearly CT to check if it's grown and am assuming it hasn't as no follow up call. I am prone to chest infections/Pneumonia so wasn't really surprised. I think if you scanned us everywhere you'll find nodules. Apparently I have some on my liver and colon too....

[Ladyhillingdon in reply to Sophiestree]

Thank You. Yes I believe in 30% people receiving a CT scan nodules are found . Have you been been more prone to chest infections since finding your nodule? Has a connection with LVV ever been suggested?

I have never had a chest infection or pneumonia in my life and last cold was six years ago. I will have to wait and see what second CT reveals in about Six weeks time.

[Sophiestree in reply to Ladyhillingdon]

I had a few chest infections but think that might have been the Actemra? Not sure really, but nothing for a while. Persistent cough is the main thing at the moment with hideous sinus issues.

[PMRpro Ambassador in reply to Sophiestree]

Have they looked for granulomatosis with polyangiitis - used to be called Wegener's? Chest and sinus problems are typical ...

[Sophiestree in reply to PMRpro]

Interesting... if they ever call me I'll ask that question!!

[ladygigger]

I had a nodule, but it was somewhat larger - 4cm, and next to a major artery in the top of my lung so that had to come out. I'd only had the x-ray initially because the rheumatologist had wanted to prescribe methotrexate to reduce my pred dose.

Just been called for a follow up scan for a nodule on my kidney.

No idea whether either of those were caused by PMR / Covid, but I was told that they both looked relatively 'new'.

[Darkchocolate1]

I have had PMR for 2 and a half years and a tiny lung nodule was seen coincidentally when I had CT of my shoulder. It was so tiny they said just scan again in one year and not to worry. Another larger nodule was seen on my thyroid and it was biopsied and found benign. Again scan again in one year. No one has suggested a link to PMR.

[Tractor_Fan]

I am invited to respond yet my situation seems atypical. I was cut down by PMR over two days and ran scared to my GP who gave Pred to snuff it, but he reacted to other symptoms of my undetected bladder cancer which was treated and beaten. Big C trumps PMR which was a sign, not a symptom, now off Pred and feeling grateful.