Polymyalgia Rheumatica - Diagnosis

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How is polymyalgia rheumatica diagnosed?

The diagnosis of polymyalgia rheumatica is suggested by the history and physical examination. The doctor frequently notes muscle tenderness and that the motion of the shoulders is limited by pain. The joints are usually not swollen. However, swelling of the small joints of the hands, wrists, and/or knees can occur. Blood testing for inflammation is generally abnormal, as indicated by a significant elevation in the erythrocyte sedimentation rate (sed rate or ESR) and/or C-reactive protein. There are no specific tests, however, for polymyalgia rheumatica and X-rays are normal. The diagnosis is based on the characteristic history of persisting muscle and joint pain and stiffness associated with elevated blood tests for inflammation, such as the ESR. It is also not unusual for patients to have slight elevations of liver blood tests.

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Comment from: Margaret, 55-64 Female (Patient) Published: April 11

I had suspected myalgic encephalomyelitis (ME) 25 years ago and things have never been the same since in terms of my fitness, weight problems and energy levels but despite that I have lived a relatively active life. I moved to Spain for the sunshine 6 years ago and it has been a hectic time, I have had some back problems for years following use of an exercise machine which I have tried to cope with by exercise and physical therapy. When it first happened the doctor just sent me for physiotherapy. I saw a doctor two years ago who basically just told me to get fitter. This winter though, I have deteriorated badly. Muscle and joint pain have reduced my mobility considerably, I couldn"t walk far and was in real pain after sitting for a while, and I couldn"t get out of a chair (or up from a toilet) unless I could push up with my arms, resulting in worsening shoulder pain. I also have some pain and tingling in one wrist and hand. I saw a new doctor and she immediately suspected polymyalgia rheumatica (PMR) but, to her surprise, the blood tests showed nothing. None the less she started me on prednisone, 50mg in the morning, reducing at ten day intervals. I thought it was just wishful thinking when I felt better the first day but it has continued and I am greatly improved. I am due to take the first reduction in two days. Very early days for me, great to feel some relief but I am concerned that there is no indication in my blood tests and also at the prospect of long term steroid use. Still, that sure beats the constant pain and immobility.

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Comment from: SavannahSandy, 65-74 Female (Patient) Published: April 16

I awoke with searing pain in my left groin. It was difficult to walk. In a day, the pain spread across a band around my hip girdle; buttocks, down both thighs and lower spine. My physician ordered an MRI and sent me to therapy, claiming that all the pain was probably referred from my back. All pain became more severe. I visited my neurosurgeon. He ordered two more MRIs, one of my shoulder and another of my upper spine. There were also a series of x-rays... all, in my uneducated opinion, not necessary. At the end of three months, I was able to see a rheumatologist. My own physician did not help make this appointment. I "present" exactly like any definition of polymyalgia rheumatica (PMR) except my blood tests are fine. I am on a very low dose of prednisone, and the doctor took me off both the Cymbalta and meloxicam I had been taking for atypical fibromyalgia, and put me on Lyrica. Pain remains but not severe. I will be 70 next month. I have been extremely fit my whole life as a swimmer, runner and fitness instructor.

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