This seems to be a junk diagnosis. Elevated sed rate and CRP, both very nonspecific, are the two tests mentioned.

BIG caution concerning treatment-it's steroids, almost always contraindicated with lyme.

Polymyalgia rheumatica (PMR)


Written by Dr Badal Pal, consultant rheumatologist

What is PMR?

Polymyalgia (poly = many; myalgia = aching muscles) rheumatica (PMR) is an inflammatory rheumatic condition. It affects around 4 per 1000 people over the age of 50 but is rare under this age. The peak age PMR occurs tends to be between 40 and 59. Symptoms can start abruptly, or can come on over a week or two.

Both men and women are equally affected but women slightly more than men. Although it is common in Caucasians and rare in Asians and Afro-Caribbeans.

What causes PMR?

Some people notice a flu-like illness just prior to the onset of symptoms - occasionally, this turns out to be caused by a parvovirus infection - but in most cases PMR is spontaneous and has no known cause.

What are the main symptoms?

PMR causes sudden/abrupt pain and morning stiffness, mainly in and around the shoulders and thighs (it may also affect the neck and torso). Often, patients cannot get out of bed without help and notice difficulty climbing stairs.

Prolonged rest or inactivity may increase the stiffness and activities such as driving become more difficult.

Other common complaints include feeling generally unwell and tired. Occasionally, a slight fever accompanies the condition. Some patients notice a loss of appetite and weight.

In the most severe form of PMR, painful inflammation occurs in the arteries in the head, particularly around the temple area: this is called temporal arteritis.

Fortunately, no organ systems are usually affected, eg no liver, kidney or lung damage occurs in typical PMR.

How is PMR investigated and confirmed?

Commonly, doctors perform two blood tests to determine whether a patient has PMR: the erythrocyte sedimentation rate (ESR) and/or the C-reactive protein (CRP) test.

Both of these blood tests give a broad indication that there is some inflammation going on in the body. Many conditions cause the ESR and CRP to change, so a number of other tests may have to be performed to exclude those that can be mistaken for PMR.

Conditions that can be mistaken for PMR

Rheumatoid arthritis (RA) .

Osteoarthritis in a number of areas such as in the neck, around the shoulders and back.

Muscle inflammation (called polymyositis).

Underactive thyroid.

Depression.

Parkinson's disease.

Fibromyalgia.

Occasionally, cancer, eg of the prostate or bone marrow (myeloma).

How is PMR often treated?

Corticosteroid drugs are the mainstay of treatment and, in most cases, there is a very quick response and improvement (often within 24 to 48 hours). These drugs help in reducing the inflammation and cause improvement in the blood test results. The most commonly prescribed of these drugs is prednisolone.

Occasionally, injectable forms of corticosteroid can be used. These need to be given every three weeks.

These drugs do not cure PMR, but suppress the inflammation and the other complaints.

How long do I need to continue with prednisolone?

One year of treatment may suffice, but about 50 per cent of patients require two or three years of medication and 30 per cent need even longer.

Is there any other treatment available for PMR?

Yes, but it is only used in patients when it becomes difficult to reduce the prednisolone after prolonged high dosages, eg 10mg or more per day for more than a year or two. In this situation, doctors prescribe 'steroid sparing drugs' such as azathioprine or methotrexate. These can be used along with the prednisolone initially, but with a view to slowly reduce and withdraw prednisolone to avoid side effects. Then, either methotrexate or azathioprine can take over the action of the corticosteroids to keep the inflammation suppressed. Azathioprine or methotrexate will be discontinued if there has been sufficient response.

What side effects can I expect from prednisolone?

Weight gain, especially around the abdomen, with a puffy face ('moon face').

Easy bruising of the skin, sometimes with little or no trauma, such as on the back of the hands.

Some patients lose a little hair.

Older patients, or those with a diagnosis of underlying diabetes, may experience rises in their blood sugar and the doctor will need to check the blood sugar.

There may be a slight rise in blood pressure and those with a known diagnosis of high blood pressure (hypertension) need to have their blood pressure checked regularly.

Bones can also become thinner (osteoporosis), but this can be countered by preventative treatment with calcium and vitamin D, hormone replacement therapy (HRT) or certain other drugs called bisphosphonates (Fosamax, Didronel or Actonel), depending on patients' circumstances.

All patients on corticosteroids should have their bone strength measured by a process known as bone densitometry (DEXA).

Caution! Patients on corticosteroids should not stop their medication suddenly as this can lead to harm. They should always carry a 'blue steroid card' that can be obtained either from their doctor or pharmacist. This will alert doctors in case of any unforeseen circumstances such as accident or illness, as temporarily the dose of corticosteroids may need to be increased in such a situation.

Are there any other types of corticosteroids that can be used?

A relatively new type of steroid called deflazacort is available, but doctors generally feel it does not have advantages over prednisolone in routine practice, except perhaps in diabetics where blood sugar control is less affected with deflazacort than with ordinary prednisolone.

Last updated 01.08.2005

Advert

Advert

Advert

This is weird I was just going to post on elevated sed rates and CRP's to see if anyone else has this going on and what are they doing.

Saw llmd for the first time yesterday and he said that it is very unusual to see these elevated blood tests with lyme.

This is my main sx.

We did another 4 weeks and zero change. The fall of 1991 I went to a rheumy and he diagnosed me with PMR and I took steroids for 2 years and boy do my bones tell the tale of that treatment.

I did get better for a few years but now am down and out but had the vaccine in 1999 and that put me to the ground.

PMR is a junk diagnosis and if she tested positive for lyme she had better weigh the consequences of the longterm price of all those steroids they are going to pump her up with that would make a dying elephant feel like they were ready to dance all night.

I went from sleeping 24/7 to sleeping 4 hrs and going like I was on fire for the rest of the day. My daughter said I was Mom to the tenth power and that was more than any daughter should have to bear. (giggle, but true)

Artificially giving your body fuel to use more energy than it can produce is a quick path to long term bad news.