7 day trial pred completed

[VueltaSkelta]

I’ve recently been diagnosed with PMR. I have completed my 7 day trial on 15 mg this morning. The pain in my right shoulder reduced significantly over the trial and I have a lot more movement than before the trial. Not pain free at night but can easily get out of bed and feeling a lot better. No stiffness during the day when getting out of a chair.

Will now have to see if the pain returns before reporting back to the doctor.

On a side note, I had an ultrasound scan on my right shoulder last week which showed tendinitis of the shoulder. I’ve not spoken to my doctor about the results, is this common with PMR? Or does this point to something else than PMR ?

[PMRpro Ambassador]

Shoulder bursitis and tendinitis are commonly seen in PMR. If it were due to injury or overuse, then you wouldn't have the pain and stiffness anywhere else.

[AtopicGuy]

Given that PMR is rare at your age, and your inflammatory markers are normal, you should be looking for a very rapid and near-100% improvement in symptoms to confirm the diagnosis. A small improvement is not enough.

Why was only one shoulder ultrasound-scanned? One of the hallmarks of PMR is that it tends to be bilateral. Joint symptoms (arthritis) are commonly found in PMR patients because their average age is about 72, not 52! Your tendonitis might be an injury, rather than evidence of a systemic, autoimmune disease like PMR.

I note your lifestyle has changed recently due to work commitments. Is it possible your body is complaining about something new that you do?

I'm impressed your doctor is using a short course of prednisolone as a diagnostic tool. The evidence of benefit must be very strong to keep taking them, due to their side effects. Did NSAIDs (non-steroidal anti-inflammatory drugs) not work?

[PMRpro Ambassador in reply to AtopicGuy]

It isn't osteoarthritis that is seen in PMR - so age actually doesn;t have much to do with it.

"Fifty-one percent of the patients with PMR presented distal musculoskeletal manifestations, with peripheral synovitis being the most frequent one. Patients with PMR with peripheral synovitis did not represent a high-risk subgroup with more severe disease. Seven patients who developed criteria for seronegative RA within the first year of follow up had presented statistically significant persistent synovitis compared with those who continued as PMR and also showed a smaller initial decrease in mean ESR after steroid treatment was initiated. The absence of persistent arthritis and the benign course of the arthritis permit the distinction of PMR from other inflammatory arthropathies."

pubmed.ncbi.nlm.nih.gov/168...

[AtopicGuy]

Nobody mentioned "osteoarthritis". Nor rheumatoid arthritis. I simply stated that arthritis (disease of the joints) is far more common in 72 year-olds (typical PMR patients) than younger people (such as 53 year-old VueltaSkelta). That's why a correlation between PMR and arthritis is likely, despite the best efforts of epidemiologists to control for such factors. "Seven patients" can offer insights, but do not represent anything statistically significant.

[PMRpro Ambassador in reply to AtopicGuy]

And I made the differentiation about the TYPE of arthritis which is seen in PMR.

[AtopicGuy in reply to PMRpro]

What's that got to do with 53 year-old VueltaSkelta's enquiry? "Tendinitis of the [right] shoulder" is not grounds to diagnose PMR (an autoimmune disease), especially in someone so young whose inflammatory markers are "normal".

[VueltaSkelta in reply to AtopicGuy]

Just to an add I have had bilateral pain in the shoulders; the right arm has been much more noticeable and hence the doctor keen to ultrasound. I couldn’t lift my arm above my head. The pain is uncomfortable but doesn’t stop me sleeping mostly.

The hips have also been painful; from my limited knowledge these are the two areas of the body that show symptoms.

The introduction of pred for the weeks trial has alleviated the majority of pain and restored 90 % of the mobility to the right arm.

[AtopicGuy in reply to VueltaSkelta]

That makes more sense. Your doctor is working through a checklist like this one (the bold is mine). The first paragraph is crucial, but often forgotten. Lots of disorders (including arthritis) can mimic PMR, so these should be excluded first. Even then, not every patient has "all" the symptoms, so not every diagnosis can be as "confident" as the list below suggests.

NHS Symptom checklist for PMR

After ruling out other possible causes of your symptoms, a checklist can be used to see if your symptoms match those most commonly associated with polymyalgia rheumatica.

Polymyalgia rheumatica can usually be confidently diagnosed if you meet all of the following criteria:

you're over 50 years of age

you have pain in your shoulders or hips

you have stiffness in the morning that lasts longer than 45 minutes

your symptoms have lasted for more than 2 weeks

blood tests show raised levels of inflammation in your body

your symptoms rapidly improve after treatment with steroids

nhs.uk/conditions/polymyalg...

[DorsetLady PMRGCAuk volunteer]

it is -

PMR main affected areas

[VueltaSkelta in reply to DorsetLady]

Thanks Dorset Lady, I do have the main pain in those areas. Have started having pain in the hands and wrists as well. My upperams are often painful just below where the pain is shown on the diagrams.

I’ve been off the trial for 3 days now and feeling a bit stiffer around the hips but still a lot better than I was.

[DorsetLady PMRGCAuk volunteer in reply to VueltaSkelta]

Many of the diagrams online don't show all the areas , just the major ones most affected - and hands/wrists are quite common.. as are knees.

Make sure you keep comments so you can discuss with your doctor.. it's easy to forget the minor things.