Could this be PMR?

Hi Eileen,

Thank you for replying and reassuring me. When I saw my GP last I was worried that I might have GCA because I have noticed raised veins on my temples. He looked and just shrugged his shoulders. I think that is why he gave me the blood test. I haven't been well for several weeks, it's knocked my confidence terribly. I do get some pain relief from anadin extra which is made up of aspirin, caffeine and paracetamol but sometimes they make my dizziness worse. My rhuematologist said to take paracetamol and capsaicin cream for painful areas. I cannot see how early stages OA are giving me all these symptoms, it doesn't make sense. My appointment is a week next Monday so I will have to go from there. I appreciate you replying.

thankyou

I'm glad you are getting more medical attention.  One thing, if you notice any changes in your vision, that's when you need to get yourself to the emergency department asap, don't wait for your appointment.  This is something we all need to keep in mind but most people who have PMR will not develop GCA.  I went around for over a year thinking that my osteoarthritis was getting worse, but it was a new doctor who recognised the signs of PMR and I've been very successfully treated.  

Good luck, and do let us know how you get on.

Hi Anhaga,

Thank you for replying. I will let you know the outcome of my appointment. If not much comes of it, do you think I should ask him to let me have prednisone for a week to see how I get on? I've read that it can have a fast response and if I start to feel better then I know we're on the right track.

Regards

Read up on the PMR and GCA symptoms.  There's information on Patient website.  That way you will know what questions you need the answers to.  Maybe write down some of the more important things which are concerning you as it's so easy to forget when you are at the appointment.  A week of moderate dose pred would not hurt you and could help the doctor with a more definite diagnosis.  My good response to pred was the confirmation my doctor needed.

https://patient.info/forums/discuss/browse/polymyalgia-rheumatica-and-gca-1708

Hi Christopher,

Thank you for your advice. My rheumatologist didn't make a further appointment because I think OA is dealt with by a GP. I don't know whether my GP can make a PMR Diagnosis without a visit to a rhuematologist.

Regards

In many places PMR is dealt with completely by the family doctor, referral made to a rheumatologist only if problems occur, although I know in other places it seems standard to get a rheumatologist's opinion and even be placed under the specialist's care.  I have both osteoarthritis (for over thirty years, nearly half my life) and PMR (about three and a half years, over one year undiagnosed because both I and my doctor at the time assumed it was OA getting worse).

Although none of us want to take steroids it's very important to remember that if they are needed to treat the inflammation of PMR they will be good for you.  Unchecked inflammation can cause serious and permanent problems of its own whereas steroid side effects are mostly temporary and can usually be managed effectively and diminish to nothing as the dose is tapered to a low level.  

Hi,

Thank you again. so sorry you have both illnesses, as if one wasn't bad enough. I agree about the steroids, I'd try anything for a normal life again. What is the affect of steroids on OA?

It sounds like you have a good relationship with your doctor. I don't know whether mine would make a diagnosis, he tends to refer a lot. What do you take for your OA, if you don't mind me asking? I've tried ibruprofen and co-codamol but they make me feel so lethargic and ill. I cannot take paracetamol on its own, it makes me naucious.

Thank you once again for your interest.

Regards

I had assumed that pred didn't affect OA, but I can tell you that in my early days ALL my aches and pains went away, including some I can only attribute to OA which I have in my spine.  Lately I've read that even OA has some inflammatory properties (kind of obvious when you think about it but it seems to be newish research) so I imagine that if anything pred is helpful in relieving OA symptoms and doesn't have any bad effects on that ailment.

Oh, and my doctor, I call her Doctor "I'm not worried about that" as she is kind of dismissive of other concerns I have.  She is very nice and has managed my PMR mostly well by letting me set my own pace of tapering.  I do miss my old retired doctor, although I wonder if he would have caught the disease.   He retired just before I became an interesting patient. It was another doctor in between who was useless in diagnosing me. 

i've never taken anything for OA pain, and other than some annoying back problems I've been pretty lucky, mostly I just have stiff fingers.  I enjoy the relief when I take aspirin for something else, like headache but things like aspirin are actually bad for arthritis as they interfere with cartilage regeneration.  I have taken a fairly high dose of glucosamine for quite a few years, and I suspect this has helped maintain the health of my joints.  It's not a pain reliever and doesn't work quickly to relieve symptoms but I think in the long term it probably is helpful.  Studies which suggest it's useless may simply not have run long enough, or have been confounded by the patient taking other medications.  I also think the complete Vitamin B complex I take is helpful.  Used to just take Vitamin B6, but as it's not a good idea to supplement only one B vitamin for a long time I decided to go with the complete.  I can't remember why I do this, but I have noticed if I stop taking the B my joints seem to get a bit stiffer. I basically refuse medication unless I absolutely need it, like I need pred.  I have maintained joint strength and flexibility by doing a little yoga and a load of physio exercises prescribed for various issues over the years.   I also used to be of normal weight and have lost a lot of weight since developing PMR, mostly before I was diagnosed, and that probably helps with keeping OA symptoms at bay as usually people are suggested to lose weight when diagnosed with OA. 

Hi Anhaga

Thank you for all of this information and for taking the time to type it. I will take on board the supplements you mention and bring it up with my GP. I too have lost weight and don't seem to be able to put weight on. I am of normal weight so I suppose that is a good thing for OA but may be indicative of PMR. I am also going to suggest trying prednisone to see if it makes a difference. My GP is well respected but relatively new to me, my regular GP passed away a few years ago. He tends to refer for diagnosis and doesn't make any suggestions, at least not with me. I'm sure it's a time thing though, in and out, if you know what I mean. Things just haven't been the same for me since I took early retirement 3 years ago. Sometimes I wonder if I should have stayed in work which would have given me less time to dwell on things. My OA is probably caused by FHP according to my rheumatologist, related to my job. Thank you so much once again.

Kind regards

Sounds a bit like me.  I retired in 2014 and had been ill for some some months before that, undiagnosed PMR.  I'd reached the end of my rope with work, although I've missed it terribly since and nothing has replaced it in my life so far.  But you get used to things, and at least being treated for PMR has helped me physically.  I try to get outdoors every day and walk a lot.

What is FHP?

Hi Anhaga,

Forward head posture. I worked on a computer every day and it seems some neck problems are through bad posture. My physio has treated many people with this. I too miss my job, I loved it. I worked in a busy college. The hours were long and the journey to and from work was tiring. I wasn't feeling quite right for some time before I finished, hence the decision to take early retirement. I love walking but these days I feel too muzzy headed and woozy, I am losing my confidence to do many of the things I loved doing for the fear of feeling ill when I am out.

" it seems some neck problems are through bad posture"

Whereas many healthcare professionals acknowledge that it can also be a case of the medical problem causing the poor posture - you automatically adopt the position that causes least pain. That was the case for me - once the medical/physical problem was worked on, my posture improved enough to slow down the development of the pain. I had a slight scoliosis which led to muscle tightness that made the scoliosis worse, round and round in circles. Sorting the muscle tightness improved the scoliosis - and over a long period has also improved the overall situation. It hasn't gone away - but it is a LOT better.

My favourite hospital staff are the rehab doctors and physios in a system that realises that hands-on physical therapy works 

Hi Lina3x

I read your post about how you are feeling muzzy headed and woozy .....i had that feeling sometime ago..along with extreme fatigue. It was eventually revealed through blood tests i had a B12 deficiency which will present with the above symptoms. As we get older the protein 'intrinsic factor' in our gut which carries the B12 through to the ileum and then through the system declines, so it will make no difference if we are eating foods that contain B12 it will not get through also certain medications such as metformin for type 2 diabetes, will block B12 absorption. In the elderly our B12 should be over 500. Ask your doc order a blood test for B12 and Folic Acid.....I now have B12 shots every 3 months and no longer get that muzzy, woozy, fatigued feeling. ....my very best wishes to you Lina3x ...

Hi Eileen,

My goodness you have been through it haven't you. You seem very knowledgeable in these conditions whether it be through experience and research or professionaly. The more I research PMR the more I am convinced I have it, probably GCA too. When I went to the optician, not my regular one, he spent more time looking in one of my eyes than the other, I thought that he must have found something wrong but he said all was fine. However, my prescription is useless and I wear my old specs. What I have noticed is that I get slight head pain after I have taken my diuretic and ssri. I know that these have an effect on blood vessels and am wondering if one of both of them are making matters worse. I have tried researching the internet but cannot find a connection with these meds and GCA. Are you aware Of Any Links??

Hi again,

That's very interesting. I had all the regular blood tests done recently, not sure if this included B12. I'll mention this to him.

Thankyou

Hi Lina3x

With a routine CBC complete blood count..B12, Folic Acid and Iron are not usually included....i had to request mine..but do ask and if not request to get them done.....have a good day Lina3x and my best wishes to you...

Possibly depending on what they are - lots of drugs cause headache as a side effect though it may not be an effect on the blood vessels.