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susan29426 susan29426

Nature of PMR pain?

I need some clarification. Thanks to Actemra, my inflammation numbers are practically at zero. Thus, according to my rheumatologist, the shoulder pain I have is no longer from PMR, since PMR pain is caused by inflammation. I do have a lot of other things going on in my shoulders which could account for the pain. But, on this site, we've heard from many people diagnosed with PMR who have low inflammation scores. So, it is then possible to still have PMR without inflammation? Also, my pain levels seem to follow the PMR model (mostly in the morning and late evening). Would appreciate any feedback. Thank you.

22 Replies

  • lodgerUK NE susan29426

    Just a not of clarification please, were you diagnosed with both PMR and GCA or just PMR?

    I am assuming it was both, because Actemra is only used for GCA in the UK.

    However, I would ask for a scan to see if the PMR has caused a rotator cuff injury, which can and does can come along with PMR.

    Now I am no expert but someone will come along who will know more than me.  But that is the question I would be asking.

    • susan29426 lodgerUK NE

      No, just PMR. I'm in the U.S. I do have rotator cuff injuries on both shoulders, this thread is the first I've heard of it being associated causally with PMR. I'm continuing to taper the prednisone - with the Actemra, I can do 0.5 decrease each month. Just trying to understand how it all fits together. If PMR is caused by inflammation, and I have none now, does that mean I am in remission from PMR? But, then, what about people who have low inflammation markers and apparently have PMR?

    • Anhaga susan29426

      I've had rotator cuff problems since onset of PMR.  Exercises given me by a physiotherapist have helped.  Also I had some low level light treatment for the first, more serious, injury which probably helped speed the healing.  I wasn't aware until recently that this was one of the add-ons which can occur with PMR.  I think it may be more to do with the muscle-weakening effects of pred.

    • Anhaga

      Need to correct what I said.  Rotator cuff issues didn't occur until I'd been on pred for well over a year.  A flare up of back issues didn't occur until even later, although I've religiously followed my exercise protocol.  This is why I blame pred not PMR itself.

  • Bethune susan29426

    I’ve had classic PMR symptoms for 8 years.  Sometimes my labs are up. Sometimes down... mostly down.  However, it is very  hard for me to get below 10 mg prednisone , though I’ve been symptom free at 5mg. for months at a time, but then flares occur.

     Predisone might also lower your inflammation numbers.

    They give Actemra in the US just for PMR , not GCA.

    • EileenH Bethune

      No Bethune. Actemra is being used for GCA, that is all it is officially approved for as a result of the phase 3 clinical trials, but rheumies seem to be carrying out their own individual patient studies in PMR when they can get funding. It is very expensive so that isn't easy - but I imagine the patients who have no insurance and so qualify for Genentech's programme provide a good source.

    • Michdonn Bethune

      Bethune, I know this sounds crazy, but have you ever tried to eliminate food from your diet that may be causing inflammation. I believe our diets have a great effect on our well being. Thinking positive, being active with a smile. ☺️

    • EileenH Bethune

      It certainly is off-label. However, your experience is very different from mine. Although on the forums we do have a few patients on Actemra for PMR it is not used anything like as much as for GCA.

  • mjhollywood susan29426

    Hi.   Same.  For me!!! my labs are great. Been on actamara for 7 months.   And yes I still have stiffness in the upper thigh area (both). I have only been effected by p m r in the thigh.. in the morning and at night !!!   Now the rummy is telling me I may have a patch nerve !!!! I don’t.   Most of theses docs don’t understand p m r.  I am down to 1 mg predsone   

  • connie28112 susan29426

    Hi Susan

    My inflammation markers have always been low and it has led to difficulty in diagnosis. My Rheumatologist agrees that it is unusual but not unheard of to have PMR without inflammation blood markers.  In addition to the morning stiffness and pain, I have had visible inflammation in/around knee joints without any markers. 


  • pauline36422 susan29426

    interesting blogg.   i am down to 2 mg.   still with bilateral pain in shoulders,  so i am thinking is it pmr. or not. so rather than risk it i have , made an appointment for bloods  doing   if they are ok   then i will start to reduce  again.   but  i have been on  cherry juice  for 4 weeks   now and i think  its begining to work, they recon it takes around 5 weeks to kick in.    but i will report back on this  in a couple of weeks

    • ptolemy Bethune

      Hi Bethune, I take cherry juice too. Apparently it is important it is the juice of the sour cherry ideally Montmorency cherries. I love cherry juice anyway. It is not that cheap though.

    • Anhaga ptolemy

      Interesting how different things seem to work for different people and have no effect on others.  Too bad we couldn't run double blind tests with a placebo to check the various things.  Not only is there cherry juice, but also aloe vera juice, liquorice, ginger, turmeric (curcumin) ....  It's important to note

      there are some contraindications for taking some of these, btw.

      Probably the best thing we can do is avoid refined cereals and sugar.


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