Rheumatologist or Primary Care Physician care
Posted , 8 users are following.
I have been with my Primary Care Physician for 13 years. Recently he mailed a letter announcing that he is retiring. He is in a practice with 2 other physicians. One is a DO and is elderly and still working at age 79. The practice is looking for another Dr. to take over my Dr's patients but are asking patients to find another provider in case it takes a long time to find a replacement. Months ago my current Dr. suggested I see a Rheumy too. I asked what more can a Rheumy do for me and I believe he said it would be drugs that he is not qualified to prescribe, such as Methotrexate. I declined the referral.
I had an appointment with a new Dr. yesterday. He knew of PMR but admitted it was limited but knew the duration was 1 1/2 years to 5. After reading everything on this forum for the last 13 months I think I impressed him with my knowledge. He seems open to me taking Pred as needed to control the symptoms while reducing, but he also asked why I haven’t been seen by a Rheumy. I said it was because I didn't think I needed drugs such as Methotrexate. My question: What might I be missing out on by not seeing a Rheumy? I am willing to see one if I know what else there might be gained.
0 likes, 7 replies
EileenH bruce105
Posted
You are in the USA I assume - in my experience, if you have a PCP who is going to allow you to manage yourself in a sensible manner you are as well sticking with them. Some rheumies, especially in the USA, have some strange ideas about PMR. Including the use of methotrexate and rushing patients off pred because they have been on it "too long". You don't say much about how long you have been on pred or at what dose - and that is also an important feature of possibly trying methotrexate as I'm sure you know if you have been around us long! If any new doctor will let you continue as you have been, keeping the rheumy for if you need one, they seem worth trying.
bruce105 EileenH
Posted
Hi Eileen,
Yes, I am in USA. I came down with symptoms Sept 2017 and started 20 mg Pred Oct 17, 2017. By end of Aug 2018 I was at 10 mg ready to go down to 9 but with a 2 week vacation to Scotland upcoming I decided to stay at 10 until we were back. Going to 9 mg in Sept I started experiencing, what I believe to be, a flare. Only a 2 weeks ago can I say it has settled down. It took going briefly up to 15 and then stepping down. Currently 11 mg & 10. Recent blood test results show low ESR (I never have had it elevated), and C-RP was 4. I was surprised because I still have some aches.
EileenH bruce105
Posted
Some people are never entirely pain-free and there can be other reasons besides the inflammation of PMR. Did the pain start as soon as you dropped to 9mg? Or was it a few days later? Immediate pain is usually your body adjusting to the change in dose - and then it improves if that is the case. Delayed pain is more likely to be a flare - and it will continue to get worse.
bruce105 EileenH
Posted
In my journal it was the third day after starting 9 I was getting out of the car in the morning and walking to the building and I noted the front hips/pelvis area a little stiff and "hadn't had that for quite a while". It did continue to get worse and 3 weeks later I increased the dose to 15 then tapered 1mg/day back to 10 where the pains were tolerable but still there when before at 10 I had very little. Still at 10.
Side issue thoughts: 11 days after starting the 9 I received the flu shot.
I also wonder about a seasonal nature of my PMR. Maybe just a coincidence that it was Sept 2017 that this all started and Sept 2018 when this flare happened.
EileenH bruce105
Posted
Lots of experts agree there is a seasonal component to PMR - more May to August so September would just fit.
https://ard.bmj.com/content/annrheumdis/49/7/521.full.pdf
and there are other articles too.
The trouble tends to be that if you go slightly too low, as you appear to have done, and then add in something that can trigger a flare on its own you are obviously more at risk - you were on the line and then the flu jab poked at your immune system. I don't believe the flu jab actually causes PMR but it can be the final straw that sends the immune system into a tail spin.
patricia43291 bruce105
Posted
My Rheumy has been pretty much useless. I've only seen him once, last February, and
my scheduled appointment last month, was rescheduled for next March. That's almost a whole year. He has no clue what I'm doing to manage my PMR. The only thing he is good for is prescribing the pred, which his office does.All my help is from this forum.
TheRaven bruce105
Posted
If you are on Pred, have kept the pain reasonably under control and have found a reduction schedule that works for you, I don't see the need for you to see a Rheumy. I am more impressed with a doctor who will admit his limitations regarding PMR - at least you should be able to work with him.
In just over 2 years time I saw 3 different Rheumys. Each felt they needed to tinker with me by adding other drugs and pushing a faster reduction of pred and I'm certain that 2 of the rheumys were the direct cause of nasty flare ups that I had. I went one time to the last rheumy and will never go back to that quack again.
I now have an agreement with my doctor (physician's assistant, actually) that as long as things are going reasonably well she'll provide the prescriptions if I stay in touch and come in occasionally. If other issues pop up that she can't handle, she'll then refer me to a different rheumy.
I understand what you mean about "missing out". There's that lingering doubt that one gets.