Doctor, newly diagnosed with presumed PMR, my experiences for interest.

Hi,

56 normally v fit consultant in NHS.

I noticed relatively rapid onset of very painful quads muscles at night on holiday after some intense exercise with a lot of stair climbing. Initially thought I'd just overdone things but there was no improvement after a few days as expected. Over next few days the symptoms became progressively worse causing waking in the middle of the night due to the pain. At its worst I simply had to get up for around an hour making tea and waiting for some relief with more NSAID's. It was very difficult to turn in bed and hard to get up in the morning due to the pain and stiffness such that I couldn't bend to pick things off the floor or tie laces without great difficulty. Symptoms were predominantly muscular and spread into the upper arms. Quite a lot of pain began in the gluteal muscles spreading into the hamstrings which made sitting uncomfortable first thing in the morning. Even walking was difficult in the mornings although things improved progressively throughout the day and with the help of NSAIAD's I was not too bad at all by the evening many days.

At around this time I also developed very sore left wrist on the opposite side to the thumb which stopped me playing golf as I could not grip the butt of the club due to the pain in my palm. As I had an old injury in this wrist which occasionally flared up I did not initially connect this with the other symptoms. I think I had also lost a little weight.

Initial thoughts were Lyme disease or Leptospirosis contracted on holiday as I had been in a prevalent area and swam in some lakes. I started Doxycycline whilst awaiting serologies at the advice of a colleague in view of the need to treat both of these diseases early.

I continued struggling into work for a couple of weeks until I finally realised I had a real problem which was causing significant sleep disturbance and consulted my GP for the first time in ages. He decided on urgent Rheumo referral although at that stage I thought it was a bit of overkill (what do I know!), still expecting things to somehow wear off spontaneously. I think he could see how ill I was more than I had realised myself.

The Rheumatologist sent the full battery of bloods but at this stage was not entirely convinced it could be PMR partly due to my age which is a little young in comparison to the majority of cases and initially prescribed stronger NSAID's together with an acid suppressing drug to help prevent gastric ulceration.

ESR and CRP were slightly raised which he felt was significant in view of my otherwise good health.

By the time of a review with the Rheumotologist 10 days later it was clear the Doxycycline had made no difference and the infectious causes of my symptoms were ruled out by the bloods. By this time both he and myself were considering PMR as the most likely diagnosis and I was ready to start steroids without further delay as the symptoms were causing such discomfort that I was really struggling to continue working.

The night after starting 15mg Prednisolone was the best night I had slept for over a month although the symptoms and morning stiffness were by no means gone.

I have now been taking Prednisolone for 9 days and am feeling a lot better. the nocturnal muscle pains have almost completely gone. Energy levels are improving, I have greatly reduced the amount of NSAID's needed to keep me going.

The painful left wrist is only improving slowly and I have had to buy some support splints to help with this.

During this illness I have tried to keep swimming which I think has helped me cope with some of the symptoms and maintain muscle muscle tone and flexibility.

In conclusion I think I have been suffering with PMR and have been fortunate to see a reasonably rapid response to steroids at not too high a dose. The diagnosis can be difficult and it can take quite a while for you to realise yourself that you are actually ill and not just suffering the effects of aging or OA flaring up.

I hope this perspective from a medically qualified patient may be of some help to fellow sufferers in making sense of their symptoms and getting diagnosed.

TheRadman

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