Possibly not PMR

[trafar]

my husband was diagnosed with PMR in May after weeks of pain. GP diagnosed PMR and gave normal treatment of steriods which helped initially. He has been trying to cut them but has had many flare ups since then GP not been great and just wants him off steroids and have been getting mixed messages from him and at his last most his words were you are to stop caning tge steriods he was on 10mg at that point, he has been loath to send him to rheumatologist so we have paid privately. We saw him yesterday and he doesn’t think he has PMR he thinks he has psoriatic arthritis has anyone else had experience of this. The next steps are bloods and an MRI scan which is going to cost us money we can’t really afford so have written to his GP to refer him.

[PMRpro Ambassador]

PsA is one of the inflammatory arthritides that can be misdiagnosed as PMR since they can have a polymyalgic presentation with no other identifying feature to differentiate them. It isn't easy and even rheumies get it wrong - the rheumy I saw in the UK was adamant I had PsA not PMR but 15+ years on it still looks like PMR rather than PsA to the world name in PMR who is now my rheumy! But I have never been able to get the pred dose down so there is obviously SOMETHING going - even if it is just a very atypical form of PMR!

What often is a sign is that the patient responds well to pred initially and then has difficulty reducing the dose. Or the response to pred is middling at best - and it sort of plods along with a moderate response and can't taper. However, there are a lot of slips associated with the tapering and your GP sounds to be in the "get off pred asap" brigade and that is not helpful with any version of PMR.

Your GP obviously knows very little about either - and I would make a formal complaint about his unwillingness to refer to a specialist. It is said that at least a third, and probably far more, of diagnoses made by GP are incorrect one way or the other. GPs are the gateway to the specialists. There are a lot of things that COULD be dealt with in general practice well - once the correct diagnosis is made. But the GPs are often not up to the specialist knowledge and experience required for that.

Is it possible to see a different GP in the practice? If not and you have any difficulty with this GP, ask to speak to the Practice Manager. Some GP get all huffy at the patient who went privately - despite the fact the rheumy also works in the NHS. If he had referred you in May, you might be closer to seeing one on the NHS now,

[Pixix]

Versus arthritis have a lot of excellent info on their web site.