Skin rashes and pmr?

Hello MsA

Well you're definitely not too young for PMR at 52, unfortunately!

Have you ever suffered from psoriasis? I have a friend who developed a rash and painful symptoms similar to those of PMR, and was diagnosed with Psoriatic Arthritis.

When ruling out other conditions at the start of my illness, one of the questions the rheumatologist asked was whether I'd ever suffered from psoriasis. Could this be a possibility for you?

MrsO

I'm just in the process of discussing this with a researcher! As MrsO says - if only 52 were too young! I was 52-ish when mine started and had 5 years where it was ignored and then, at 57, I had a rheumy who wanted it to be anything rheumatic besides PMR. Thank goodness for a sensible GP.

PMR is the name for a set of symptoms - but there are a lot of causes of "many painful muscles" and there are be other vasculitides (caused by inflamed blood vessels) that can result in the symptoms as well as the ones specific to their own label. You might find the vasculitis section on the Health Unlocked forum can provide some suggestions and also about who they see for similar problems - I suspect it isn't by any means always a rheumatologist and certainly not for long term care.

I googled "healthunlocked vascultis forum" and got links to the forum - I'd give it you but then this post will disappear for a few days. Urticarial vasculitis itself can cause joint pain - you say you have some PMR symptoms but which in particular?

Hope this helps

Eileen

Hello MsA,

I was just reading the possible side effects of prednisolone and one of them is hives. Please tell your GP as you might be reacting to the steroids.

Best wishes,

Christine

Thanks Eileen, MrsO and Christine.

I have the classic 'can't get up out of a chair', sore shoulder joints, sore neck, weak and painful arm muscles and thigh muscles, sore knees too. Most of these built up slowly over weeks; the initial pain was in the back of my neck and in my groin.

Just to clarify, I'm not on prednisolone (yet!), as my rheumatologist wants to rule out everything else possible first. Interestingly, when I first went to my GP in early October after I woke up suddenly at the end of Sept with a very sore neck etc etc, she immediately said 'it's pmr', especially when raised ESR and CRP levels came back. At the time I hadn't heard of pmr. I was more worried I had some sort of cervical collapse, so she referred me to the rheumy for more blood tests, X rays and eventually an MRI scan of my hips which revealed bursitis-type inflammation.

My GPs (as I've seen 3 different ones over the period) are sympathetic and have lots of pmr experience, so all good there. No one wants to (can?) link my recent outburst of hives to the pmr, or to the fact that in mid Jan my rheumy decided to give me a single shot of steriods in my right hip which was meant to last just 4-6 weeks only - it was really a 'tester' to see if my symptoms were relieved at all. It's now 5 weeks since the steriod shot, and the hives flare up kicked in after almost 4 weeks ... suspicious don't you think?

The steriod shot did relieve the symptoms a little, I guess not surprising, but I tell you what gave me the most lovely relief last week. My face became swollen really badly during the hives attack, which whilst very worrying in itself, my dear old body reacted by flooding me with 'anti-inflammatories' and just for a couple of days all my pmr symptoms virtually disappeared! It was lovely! Well, until my face went down again that is, then bang, back to earth as my symptoms - plus sore elbows as well - came flooding back worse than before.

Also my GP put the wind up me last week as I had yet another conversation with her about whether to go onto long term steroids. I've been really interested in the posts from people who have been trying to tackle pmr without pred. I'm going to an acupuncturist-health promoter this week for the first time who has helped a friend keep cancer in check and another to get on top of severe ezcema - I'm hoping! Anyway the GP said to me that I'm running the risk of cardiovascular disease amongst other things because I'm doing so little cardio exercise. So a couple of days ago when the sun was shining (!) I got on my bike and madly cycled several miles along the river! Afterwards I felt terrible - really sore hips, bum everything was complaining. Could barely get out of bed the next day. But then I gave myself a big lie in this morning which normally would make me feel even worse ... and I felt much better, hardly any pmr symptoms at all when I woke up!!! What is going on??

So, I'm sorry to ramble on so much, but what with one thing and another I am totally confused about what to do, when to do it and how I'll feel afterwards!

I've just popped to chemists to get some benadryl and at last my itchiness from the hives is dying down a little bit ... I'll stop now, but it's really helped to pour all this out, thanks for reading and thinking about me.

MsA

I will recommend you to one of my favourite publications:

"Our approach to the diagnosis and treatment of polymyalgia rheumatica and giant cell (temporal) arteritis by Quick and Kirwan

You fit his criteria - and his technique is to give a pred sandwich: a week of vit C, a week of 15mg pred and a further week of vit C (vit C does nothing but it's the taking the tablet bit I imagine). If the symptoms improve dramatically within a couple of days of starting the pred and then return just as dramatically on stopping it he takes that as confirmation of PMR. Other things show either no or very little improvement.

This paper is aimed at GPs to diagnose and treat PMR and that trial would seem a not unreasonable thing to do. The rheumy is, of course, quite right to want to rule out all else - if only they were all as careful.

Have you seen my stuff about "doing it the non-pred way"? I had 5 years of PMR pre-pred (not through choice) and it was aqua aerobics, Pilates, Iyengar yoga (all modified a bit to my level), an osteopath and Bowen therapy that kept me mobile and relatively pain-free. Didn't deal with the upper arm and thigh pain after exercise though. I never tried acupuncture but I have heard mixed reports of how effective it is. Diet doesn't appear to achieve much. I too would have good days when I didn't hurt so much - usually, it has to be said, after a bad night when I'd tossed and turned so didn't stiffen up. And an early morning aqua class left me almost mobile for the rest of the day - until after 5 years the 10 ton truck hit and I couldn't get dressed never mind get out the door.

Don't apologise for pouring it all out - whether you have PMR or not, you have something that is affecting you in a way we can understand having been there. Unlike the neighbours or your family.

Eileen

PS The link to that paper is here:

https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316

Your GPs shouldn't object to trying it - it is aimed at them. And, by the way, for your rheumy's information the BSR Guidelines for PMR now say "over 50" - it was "over 55". Maybe he's not bothered reading the latest edition ;-)

Hi. Eileen

Just thought to catch up with you, I too have been troubled by an itchy patch at the top of my leg for a few days, seems to arrive at night when I am in bed, I find that Eurex Cream helps, so maybe your readers may wish

to give it a go, I get it on prescription.

I have now made an appointment to see my GP on the 28th re my PMR that we have been discussing, and re my recent meeting with that horrible Rheumi man of last week.

Is it normal with PMR to have some good days? as well as bad days? and also for PMR pains to come back during the course of the day, as well as being there in the mornings, I am now having problems to lift my arms,over my head,now on the lower dose of Preds. and I do have to push myself to do things some days, and as for my sleep patters, some nights I sleep through, other nights I am still awake at 3am.

Can the Preds uoset my IBS?

I am irritable I suppose it is all down to pain, etc, fatigue

Thanks again for your help and advice

regards

Irene /Escot

Yes - it is common to have ups and downs and mostly the downs come when you did too much the day before because you were having an up!

The main cause for the pain returning during the day is because you are on too low a dose of pred - and since you mention "the lower dose of pred" I'd say you have reduced too far.

It is unlikely pred would upset IBS - more likely the other way round! What other medications are you taking?

Though pred CAN make you irritable and moody - but then, so does PMR!

Eileen

Hi Eileen

Many thanks for responding to me re the above.... I am looking forward to seeing my own GP now,on the 28th Feb(the one who has been on Maternity leave. I can say, what with the Rheumi telling me last week that he was sure that I do not have PMR, he claims he is an expert, and now that I have calmed down from him,and reading information from you, and also re PMR I am sure that he just does not have a clue. My question is that if he thought I did not have PMR, how could he predict how much oain I would have as I reduce the Preds,also re my bones crumbling, and even if the ESR has been reduced, I am sure that this would be the case as the result of the steroids. He was quick enought to tell me what I did not have,but he did not tell me with his expertise as to what I do have...also he wants to see me in May for a follow up....."For what? and as I told you the clinic called me to say all the blood tests came back normal....I have not had the clinical nurse call me to explain as to the nornal ranges.

Would havu=ing spinal stenosis upset the IBS, or is it just the stress, I think that I did read that PMR could cause Diarehea as well as constipation. I know some fruit can cause it also.

I told you about my husband also with his Turps, still no news of results, despite contacting Pals, they said last week they would be back within a few days, and when he called them yesterday, they claim that they are still waiting for feedback.....really not good enough. Added to all this, we have another problem

on our hands, now, my husband has an elderly Aunt 92yrs old, she is frail,andwas taken into hospital

yesterday, she is unable to stand or walk, my husband is next of kin,also we live closest to her, she has a niece who is not well, and another niece in USA. so for support I help my husband with this Aunty.

She should be in a care home, but refuses to go,she is always falling and has not been outside her honme for more than 3yrs, On Sunday last she fell getting out of her chair,and although she was checked over ny paramedics, they claim that she was OK to stay at home, we were alerted at 7.15am, on Monday, we were alerted at 7,45, that she was unable to get out of bed.or stand ,so they took her off to hospital. she is now in a rehab hospital, but she has a urine infection which has been left unatended because she has not seen the Dr as yet he will see her this afternoon

Why I am telling youall this, is because of the added stress that we have....which I am sure is not heloing both of us, My husband is on edge because he does not have his results, I am on edge,because of my

pains etc,and I am trying not to mention to him any of my health issues.

You ask me as to what other medications I am on

Losec

Lo-Frusomide

Vit D

Eileen you are a great help to me,

Kindregards

Irene/Escot

Losec (also known as omeprazole) often causes upset stomachs and quite a few ladies have refused to take it as it made them ill. They tried other versions of that sort of antacid tablet (called PPIs) and they were the same so many of them resorted to eating yogurt instead as stomach protection for the pred.

If you need something because of a problem other than just the steroids (reflux or hiatus hernia) you could ask the GP if you could try an older sort called H2 inhibitors - the best known is Zantac.

Are you just taking vit D tablets or are they vit D and calcium? If they are combined vitD/calcium they sometimes cause an upset stomach too - there are other versions, including soluble ones which may be better.

I do appreciate the problem of the elderly aunt - however, both you and your husband are not well yourselves and you have to put yourselves first or you will be no use to yourselves or anyone else. You are quite right - all this stress is making you ill too.

I'm afraid that if she needs constant care she needs to be in a residential home - whether she likes it or not. You are in no fit state to be able to look after someone who can't help themselves - if she is OK to manage with carers visiting once the urinary tract infection is sorted out fair enough but not otherwise. urinary tract infections are the most common reason for elderly people having to be admitted to hospital - my daughter is a paramedic and it is a major problem.

One of the things that helps with getting over PMR is to learn to say no. Whether we like it or not we are able to less as we get older and when we then develop a chronic illness it is even worse. It sounds selfish and uncaring - it isn't.

MS A,

The first thing I thought of when you mentioned the rash was the butterfly rash or malar rash often seen in dermatomyositis and lupus erythematosus. But hard to tell what type of rash you are describing. As your doctor mentioned it was odd at your age these could be worth researching. Hope things get better soon, and lots of support here on the forums if you need it! Best wishes!

Thanks chrisw10 - just sent the day getting to dermatologists appointments etc - there is now controversy over whether my rash is uticarial or good old eczema with an infection to boot! I've had 4 different diagnoses already this week and now I'm in a whirl!

I've tested negative for lupus but will go back to my rheumy in a couple of weeks so will bring all that up again … oh boy

MsA

I was diagnosed with PMR 14 years ago. Soon after was placed on prednisone.......which helped immensely.  I have taken various strengths since but currently on low dose of 5 mg daily.  Not sure it is actually helping at this point.   Soon after my diagnosis of PMR I developed a blotchy, itchy rash.  I had allergy tests, was given prescription drugs, tried every salve.  Nothing helped. The only relief I received was placing an ice pack on rash.  I kept asking my dermatologist and GP if the rash was connected to PMR.  They kept saying absolutely not.  Eventually the rash went away.  Now 14 years later the rash is back.  It was diagnosed as immune system misfire.   In my own mind I still think it is connected to PMR.    PMR is an autoimmune disease.

Another point is I was told PMR will disappear after a time.   I think I still have it with spinal stenosis (diagnosed after CAT scan).   

My my opinion is the rash is connected to PMR. 

Incidently I am 89 years old.