Clinical manifestations of GCA and PMR - the latest versions from Uptodate

[PMRpro]

uptodate.com/contents/clini...

uptodate.com/contents/clini...

This site is a very reliable and current source of information aimed at the medical community but they do also provide two levels of information for patients, Basics and Beyond the Basics, and it may be worth asking your doctor to read this and print them off for you. There are things in the articles we might dispute - but they are based on facts established in clinical studies and professional experience which is what they are prepared to take notice of.

I think they are probably something to offer to your GP if they seem a bit clueless about PMR and/or GCA in diagnosing you as they are very detailed and include many aspects of the disorders and possible alternatives suggested by atypical presentations.

[Missus835]

What a great article! Thanks for sharing Pro. I will offer to new GP although she's far from clueless. It's the rheumy who needs it.

[PMRpro Ambassador in reply to Missus835]

Seems to be not uncommon!

[yogabonnie]

Thanks for this. I thought it was great but then clicked on beyond the basics article for patients and read it we will have to take glucocorticoids for 1 to 2 years. HA!

[PMRpro Ambassador in reply to yogabonnie]

Well yes - I said there are flaws and that is a major one!

[Pangolin43]

A really good read. Thank you for posting.

[Jbobby]

Thanks so much PMRpro, this is really interesting and useful, flaws ‘n’ all!

[Broseley]

Thank you PMRPro. I will pass to my rheumy.

Have you had your ablation yet? If so, I hope it went well!

[PMRpro Ambassador in reply to Broseley]

No - they went on strike for the day, very British and for a similar reason - Rome is threatening to mess with their pensions! So postponed to Jan 9th as long as they don't go on strike again ...

[Broseley in reply to PMRpro]

Oh, I'm sorry. I hope you get to relax over Christmas.

[AtopicGuy]

The paper on PMR makes no mention of a proportion of patients having both normal ESR and normal CRP. In fact it places huge reliance on CRP alone: "A diagnostic cut-off value for elevations of the CRP (ie, below which the diagnosis is ruled out) has not been established, but practically speaking, a normal CRP effectively excludes the diagnosis of PMR."

[Broseley in reply to AtopicGuy]

I'm sure I read that it does.

[AtopicGuy in reply to Broseley]

Are you referring to the 1.0% to 1.5% of diagnoses (mentioned in studies) that are implied to be mistaken? "As noted above, a small percentage of patients with bona fide PMR have lower ESRs at the time of diagnosis... A normal or modestly elevated ESR by itself should not deter consideration of a diagnosis of PMR in the appropriate clinical setting, but the combination of a normal ESR plus a normal CRP renders the diagnosis much less likely." Nowhere in the paper does it state that a (bona fide) diagnosis of PMR can be made when both ESR & CRP are normal.

[Broseley in reply to AtopicGuy]

Ok, I'll take your word for it. I haven't got time to read it all again!