Blood marker-less diagnosis of PMR?
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I was given a preliminary diagnosis of PMR based solely on clinical grounds: all blood markers for inflammation are negative; all the symptoms are there except for shoulder stiffness (I do not have trouble combing myself), however, stiffness elsewhere is ever worse (hips, neck, thighs, buttocks, biceps, even pectorals and abdominals during flareups) and makes me walk like a robot during flares. My eye muscles are particularly affected, I can only read for a few minutes and in a totally upright position, if I read in bed, for example, I hurt at the eyes and get dizzy, it is because of the stiff neck; a head-forward position strains already-affected neck muscles and the referred pain shoots up to the eyes. All along I had though I had fibromyalgia, but this is different. Male, 56.
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EileenH glimon
Posted
Diagnosis of PMR is a diagnosis of exclusion - and using clinical symptoms with supporting evidence if it is avaiable. About a fifth of patients don't show the inflammatory markers
However, your trial of pred wasn't much of a trial - you really do need 15mg for the majority of people and men, generally being larger, may need a bit more. 10mg is unlikely to do much at all.
The latest international guidelines say "the lowest effective dose in the range 12.5-25mg". If the pain responds even partially to the pred it isn't fibromyalgia - that is a definite.
glimon EileenH
Posted
Both you and Celia14153 and you concur on the low dose, experientially. I will check back with my GP for a second trial. The med test as a discrimination tool vs fibromyalgia is quite interesting.
EileenH glimon
Posted
Googling polymyalgia rheumatica with normal ESR brought links to the first two of these papers and the third was quoted in one of them:
The ESR in the diagnosis and management of the polymyalgia rheumatica/giant cell arteritis syndrome M. E. ELLIS AND S. RALSTON
Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate.Helfgott SM, Kieval RI
Polymyalgia rheumatica without significantly increased erythrocyte sedimentation rate. A more benign syndrome. González-Gay MA, Rodríguez-Valverde V, Blanco R, Fernández-Sueiro JL, Armona J, Figueroa M, Martínez-Taboada VM
The papers might as well not exist according to a lot of doctors - but exist they do.
glimon EileenH
Posted
glimon EileenH
Posted
Wow!
"More often in men" check
"Starts earlier" check (I was 46 when symptoms started)
Any comment on normal CRP? Is it used to diagnose PMR?
Thanks.
EileenH glimon
Posted
CRP is a protein in the blood - one of the proteins that contribute to the ESR being raised - and is produced in the liver in response to inflammation being present in the body. Any inflammation pretty much so it is very non-specific. And some people simply don't "mount the acute phase response" as the medical people say. There are other "acute phase reactants", ferritin is one. My ferritin is raised - ESR and CRP bumble along at the bottom of the normal range.
Raised ESR and CRP are used to support a diagnosis of PMR - but they are only part of the picture. They should be treating the patient not the lab results - but there is a generation of doctors that is fixated on numbers...
glimon EileenH
Posted