Newly diagnosed (self) plus proposition | Arthritis Information

 

Hi Everybody:

I came across this forum after an exhaustive internet search regarding Polymyalgia Rheumatica, and have found it immensely helpful -- I have read virtually every post. I believe that I have PMR, even though it has not yet been confirmed by my rheumatologist. Please excuse the length of this post, but I feel the details might be useful to others.

I want to begin this small novella of a post with a proposition to the other members of the forum. I am self-employed, work at home, and have a small software company (with a partner) that specializes in conducting on-line surveys for other companies -- e.g. employee satisfaction, customer satisfaction, etc. My background includes a Ph.D in immunology. What I have found while reading through the entries in this forum, as well as conducting various web searches, is that there is a tremendous amount of anecdotal data out there regarding PMR, but apparently very little systemic data collection to categorize various aspects of the disease. Almost every article describing PMR says the same thing -- little or no incidence below age 50, more women than men, average age of onset 70, self-limiting lasting anywhere between 1-4 years, successful treatment of symptoms with Prednisone, etc., etc. What I think would be most helpful to both patients and doctors dealing with PMR is to collect a standard set of information for PMR patients that could be used as a starting point for people who are new to the disease. An on-line survey with an appropriate set of questions would be perfect for collecting such information, with responses being collected into a database from which a variety of useful reports and graphs could be created. This is exactly what our company does. I would like to host such a survey on our website and assuming I can collect a sufficient amount of data, start publishing the results for all to see. I believe that a good starting point would be the members of this forum, and if there is sufficient interest I would then try to get other sites interested, and perhaps get some rheumatologists with PMR patients as well. The sort of questions asked in the survey would include:

1) Gender
2) Age at onset of symptoms
3) Age at diagnosis
4) Weight at diagnosis -- useful for calculation of dosage as mg/kg, as opposed to absolute dosage
5) Initial symptoms
6) Primary areas of body with symptoms
7) ESR and CRP test results
8) Incidence of temporal (Giant Cell) arteritis
9) Initial dose of Prednisone
10) Prednisone dosage regimen (morning only, night only, split, etc.
11) Prednisone tapering schedule
12) Prednisone side effects and extent of such -- e.g. weight gain, osteoporosis, skin changes, etc.
13) Length of illness, from initial symptoms/diagnosis to remission (if applicable)

Please feel free to comment on these questions and perhaps add your own. When I feel we have a stable set of questions, I will create the survey, post it on our website, and put the link in a new forum entry so that the members can comment on it. Assuming the survey passes muster with the members, I will open it up for responses.

My problems started out about a month ago with what I thought was a mild case of sciatica down my right buttock and leg, and was at its worst in the morning and late at night. Within two weeks it progressed to pain in both thighs and buttocks, again at its worst on first getting up in the morning. Within three weeks, I started feeling some pain and stiffness in both shoulders.  At this point I ended up flying to the Pacific Northwest with my wife to visit her terminally ill father, where the symptoms accelerated in terms of amount of pain and stiffness. By four weeks, it was impossible to sleep through the night, and I began to dread going to bed. A long hot shower in the morning was quite helpful in loosening me up so that I was able to function, albeit at a much lower level than before. Every day was different, with some days having more problems with the hips and thighs, and other days with the shoulders.  From the beginning I was taking two 220 mg over the counter Naproxen tablets morning and night with meals, although it did not seem to help too much.

Upon returning home, I did a Google search with the search term: "shoulder pain" bilateral. The second entry was an article on Polymialgia Rheumatica (http://www.medical-library.org/journals2a/Polymialgia_Rheumatica2.htm), where the description of the symptoms fitted me to a tee. I spent the rest of the day reading articles on PMR. The next day I had an appointment with my GP, where I gave him my diagnosis, which he did not reject out of hand, but insisted on doing extensive blood work to rule out other possibilities (e.g. Lyme disease, RA, etc.) before suggesting any treatment. It was a long three days before the results were in, and the only significant finding was significantly elevated CRP. ESR was normal, Lyme test negative, RA, ANA, etc. negative. With this set of test results, my GP said the next step was to see a rheumatologist, and fortunately I was able to secure an appointment with one the next day. The rheumatologist was quite patient, listened to my description of the progression of symptoms, and did some evaluation of range of motion on my shoulders and hips. She felt that my diagnosis of PMR was not all that likely because of my age (59), at which point I said that according to what I found on the web, it was not that unusual, especially among men.  With that, she put me on a 20 mg dosage of Prednisone (2 10 mg tablets), ordered an x-ray of my hips and pelvis, requested a follow-up CRP blood test in two weeks (using the same lab), and set me up with an appointment to see her in 3 weeks. She also gave me a prescription for Actonel and said I should immediately start with Calcium + Vitamin D supplements (e.g. Caltrate 600+D). I got the Actonel, but after reading about all of its side effects decided to put off taking it for a while.

When I went to pick up the prescriptions that afternoon (this past Wednesday) I asked the pharmacist about the timing of taking the Prednisone -- should I take all of it in the morning, all at night, split it 50-50, etc. -- and the pharmacist said take it at night. At this point I had not done any real research on dosage and timing of Prednisone, so I did not realize that most doctors want you to take it all first thing in the morning with breakfast. I was quite anxious to see if the Prednisone would relieve my symptoms, so I took the first dose that night with dinner. Like many of you have experienced, the relief was quite rapid over the next few hours, and I got my first decent night's sleep in weeks. The next day I researched the timing issue and discovered that the consensus was the opposite of what my pharmacist said, so I called the rheumatologist who confirmed that I should take it all in the morning, and skip the evening dose. I ignored this and took 10 mg that night so I could sleep properly, and followed it up with 20 mg the following morning (this past Friday). Friday was the best day I have had in weeks, and I was able to sleep quite well until I woke up at 4:00 AM on Saturday (yesterday) stiff as a board with considerable pain in the shoulders, and lesser pain the in the hips and legs. A long hot shower at 6:00 AM helped, and I took the 20 mg of Prednisone at around 8:00 AM with breakfast.  By noon, the Prednisone seemed to have kicked in quite effectively.

By this time I had read through many of the entries in this forum, paying special attention to those dealing with tapering schedules, dosage regimens (i.e. split vs. once a day), and use of Tylenol or NSAIDs (Ibuprofen, Naproxen). Rather than attempt a split regimen without discussing it with my rheumatologist (say 15 mg morning, 5 evening) to help me get through the night, I decided to take two 220 mg Naproxen tablets in the evening to see if that would take the edge off so I did not wake at 4:00 AM similar to the previous evening. I can report that this did seem to help, although I did have some stiffness and pain in the shoulders, but nothing like the night before. I will try the same thing today, and then call the rheumatologist tomorrow to discuss a split to make it easier to sleep at night.  I had my 20 mg this morning at 8:00 Am and by 10:30 it was clearly kicking in.

My guess is that the rheumatologist will keep me at 20 mg until my next appointment, and then, depending on the results of the CRP test, perhaps make an adjustment. Like most of you, I want to taper off as quickly as possible, so as to limit the pernicious side effects of the Prednisone, but to also limit pain/stiffness flare-ups. I am reasonably active for my age, with my main exercise being walking several miles a day weather permitting. I have continued this regimen throughout the last few weeks whenever my stiffness and pain permitted it, and have walked 3-4 miles each of the last 4 days.

Hi Elliott

Welcome to the forum.  Sad you had to find us because of PMRA.  I agree with your findings on the research regarding this issue.  The disease, according to my rheumatologist has been around for a very long time.  It was originally called Senile Rheumatic Gout, and since the early years not much else besides Prednisone has sadly worked on the symptoms.  The rest of the NSAIDS and other RA medications, also bring some relief.

Either way, all the medications have side effects.  I, too, must take Actonel and the chasers of Vitamin D and Calcium.  It's like a Chemistry class.   I wish more were being done to help publicize this disease.  I am 53 and have been diagnosed with PMRA for14 months.  I think a full data base with information would be fantastic.  I wish more more doctor's and Arthritis centers would get a  grant and do more research.  There are many symptoms that seem to be connected with this disease.  There are the usual areas, but the hand issues, the leg weakness, etc are all connected to this puzzle, somehow.

I hope we can all give you the information you meed.  Nice to meet you at the PMRA picnic table.  I think the "boat" we used to all be on has hit a reef.

 

Donna NY/PA

Hi Elliott: Welcome Elliott, The captain appear to have jumped ship and this task master has been taking a break since the old forum became defunct -ut I have returned and all I can say is: my whip is cracking you better be rowing!!Hello to all:

Thanks for the replies and support.

SheilaB: As indicated in my long post, I will be creating an on-line survey (questionnaire) for collecting this information that I will host on my business website. When I complete the first draft of it, I will create a new thread with a link to the survey so that people in this forum can comment and suggest changes. The survey responses will be collected in a database from which I will be able to create a variety of reports. My goal is to attempt to to create a set of standardized measures of this disease, its diagnosis, progression, and treatment. This will allow for a uniform set of responses rather than the tremendous amount of ad hoc and anecdotal information out there that is hard to categorize.

Wildflower: There does indeed appear to be a link between PMR and GCA. The following is an excellent link to up-to-date information regarding GCA:

http://www.uptodate.com/patients/content/topic.do?topicKey=arth_rhe/5721

Donna NY/PA: After I found this site I read virtually every thread to glean as much information from actual PMR sufferers, and found the information and case histories tremendously helpful.

I am hoping to get as many responses to the survey from members of this forum as possible. I also intend to contact the new site in the UK (http://www.pmr-gca.org.uk) and see if I can interest my rheumatologist in helping find other responders. It might be quite interesting to get responses from both PMR patients and doctors who treat PMR patients.

A fresh look at polymyalgia rheumatica

A. Samanta and J. Kendall

University Hospitals of Leicester NHS Trust, Department of Rheumatology, Leicester Royal Infirmary, Leicester LE1 5WW, UK

SIR, It is time to take a fresh look at polymyalgia rheumatica (PMR). PMR is a clinical syndrome of unknown aetiology, and is characterized by aching, pain and stiffness in the proximal muscle groups, namely the shoulder and pelvic girdles and the neck. PMR usually occurs in the over fifties and often presents a ‘challenge’ because of the lack of definitive diagnostic criteria, the large number of differential diagnoses, atypical clinical features and lack of conformity in therapeutic regimes.

Epidemiological studies have shown that the incidence of PMR varies, and that this increases with age. The incidence per 100 000 of the population aged above 50 yr has been reported between 12.7 and 68.3, and would appear to be more common in Scandinavia and North America [1]. The estimated prevalence of PMR is 0.5% in people over 50 in North America [2] and as much as 2% in people over 60 in the UK [3].

As PMR can mimic a number of different clinical conditions it is essential that any effective strategy directed at this condition should have clear criteria, which enable the diagnosis to be made. Currently there are a number of different criteria sets, all of which differ slightly. The main sets of criteria used are shown in Table 1

View this table: [in this window] [in a new window]   TABLE 1. The main sets of diagnostic criteria for PMR

 
At the European Congress of Rheumatology held in Prague in June 2001, experts met in an attempt to develop a consensus opinion on the diagnosis and management of PMR. Data from over 200 patients, judged by a consensus opinion of experts to have PMR, were compared against the commonly used diagnostic criteria sets. Using the Bird criteria, along with the additional criterion of a brisk response to oral steroids, provided a sensitivity of 99% in the diagnosis of PMR [7].

There is likewise a lack of clear agreement regarding which criteria to use in assessing remission. A range of clinical and serological features which might indicate remission were examined and these included visual analogue scale (VAS) pain score, VAS physician assessment, morning stiffness, elevation of upper limbs, myalgia, tenderness on pressure of upper or lower limbs, response time after initiation of steroids, headache and masseter muscle claudication. Serological markers analysed were erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haemoglobin, serum iron and

A further issue of clinical importance might lie in determining the severity of the disease at an early stage. Subjects with more severe disease may require steroids for longer periods, and it may be more difficult to ‘wean off’ steroids in this group. In a preliminary study involving 30 patients, the severity of PMR could be determined by using a combination of ESR and interleukin-6 (IL-6) levels [9]. Patients with mild disease had an ESR < 50 mm/h and normal IL-6 levels; those with moderate or severe disease had an ESR > 50 mm/h with either a moderately or strongly elevated IL-6 level. Thus, IL-6 levels in combination with the ESR may be of value in determining disease severity and in predicting the outcome in subgroups of patients with PMR.

Studies undertaken to evaluate the management of PMR have shown that there is considerable variation in the approach to the diagnosis and management of this condition [10]. In a practical sense, patients may, therefore, end up with a widely fluctuating steroid dosage, and may ‘yo-yo’ between high and low doses of steroids. As a result, there is a higher chance that they may incur side-effects or become steroid-dependent in the long term.

The overarching objective of any clinical management strategy is to improve patient care. We believe that the management of PMR lends itself ideally to a ‘building bridges' approach, by developing a partnership between health care providers across the primary and secondary care divide. The ethos of such an approach is based on the implementation of the principles of clinical governance in primary and secondary care, and aims to facilitate best practice. However, such an approach needs to be underpinned by a consensus opinion on the diagnostic and remission criteria of PMR, and also needs to be followed by appropriately structured interface audits to demonstrate continuous improvement.

We are grateful to Professor H. Bird for his helpful comments and to Mrs S. Robinson for her secretarial assistance.

Notes

Correspondence to: A Samanta.

References

1. Salvarani C, Macchioni P, Bioardi L. Polymyalgia rheumatica. Lancet1997;350:43–7.
2. Chuang T, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica—a 10 year epidemiological and clinical study. Ann Intern Med1982;97:672–80.
3. Kyle V. Polymyalgia rheumatica. Prescribers' J1997;3:138–44.
4. Healey LA. Long-term follow-up of polymyalgia rheumatica: evidence for synovitis. Semin Arthritis Rheum1984;13:322–8.
5. Jones JG, Hazleman BL. Prognosis and management of polymyalgia rheumatica. Ann Rheum Dis1981;40:1–5.
6. Bird HA, Esselinckx W, Dixon AS, Mowatt A, Wood PH. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis1979;38:434–5.
7. Bird H. European diagnostic criteria for polymyalgia rheumatica. Ann Rheum Dis 2001;60 (Suppl. l):10.
8. Leeb B. Polymyalgia rheumatic remission criteria. Ann Rheum Dis 2001;60(Suppl. 1):10–11.
9. Hunder GG. Presented at the Annual Congress of Rheumatology, EULAR, June 2001.
10. Chakravarty K, Elgabasi SHS, Scott DGI, Merry P. A district audit on the management of polymyalgia rheumatica and giant cell arteritis. Br J Rheumatol1994;33:152–6.[Abstract/Free Full Text]

Here is the link also.... http://rheumatology.oxfordjournals.org/cgi/content/full/41/12/1455

Thanks, Elliott for the link--I learned things  I did not know about GCA.  I have no signs of it, but I want to be mindful of it as well.  GCA sounds worse than PMR because it can affect the vision. Hello to all:

As promised, I have created an on-line survey to collect what I hope will be useful information for all PMR sufferers. The link to the survey is:

http://www.quantisurve.com/cgi-bin/pmr.asp

In addition to the questions already in the survey, my business partner had some other possible suggestions:

1) How much time passed before you went to a doctor for diagnosis?

2) Was the initial diagnosis correct?

3) How many doctors did you see until the proper diagnosis was made?

4) Add a note about making results available when there are enough responses and where you will be able view the results.

5) Add a note on the survey page about passing the URL on to anyone else you know with PMR. This would be in addition to the same note that appears in the page generated when you submit a response.

6) Include a comments text box with question 7 (progression of symptoms) to provide more details about the progressions.

7) Include a comments text box with some of the other questions.

Please do not respond to the survey because it will not be final until I incorporate the thoughts of members of this forum. If you do feel like responding to get a feel for filling out the survey, that is fine, but be aware your response will be discarded.

I originally said that I would start a new thread for this, but I figured I would place it in this one first. Would it be useful to create a new thread as well?
kirbycat2008-04-21 13:18:28Hello again:

Interestingly enough, it appears that two of the forum members have responded to the survey despite my warnings about it being preliminary.  If there are no substantial changes to the survey, I will try to preserve these responses as best I can.

I also just sent an email to the contact for the new support group in the UK that has been mentioned in prior posts on this forum:

http://www.pmr-gca.org.uk

I basically repeated my thoughts regarding the survey from my original post, while mentioning this forum (provided a link) and also provided a link to the survey to solicit their input as well.

In terms of my condition, the 20 mg morning dose of Prednisone seems to be working quite well, while the nightly dose of Naproxen appears to take the bite off the morning stiffness and pain when the Prednisone starts wearing off.  So far no apparent Prednisone side effects, although I guess at only one week of treatment it is still early in the game!
I have read many times that they really have no idea what might cause this disease, but there have been suggestions that a virus could be at the bottom of this and other auto immune problems.  One virus that is often mentioned is the Herpes Virus.  I wonder how many of us suffer from this virus?  Could it be that this virus lowers our immune response and therefore we're more susceptible? Susan, I have not heard of this, but I have Herpes Simplex 1.  I have not had an outbreak in years.  As probably all of us, I had chicken pox as a child.  Would that be a consideration also? Again, something to think about!Having Chicken Pox wouldn't cause Herpes Simplex 1, but the virus itself (chicken pox) lies dorment for a long time....sometimes never rearing its ugly head until we are much, much older and is usually due to stress, comprised immune systems, etc., and the result is Shingles or Herpes Zoster.  Since PMR effects mainly older people sometimes the steriods that are there to help us will cause a Shingles utbreak because they mess with our already sad immune systems.  Herpes 1 and 2 .....different animal.   I read on one of the Herpes Forums that there seems to be some correlation between HSV-2 and RA.  I have always read, while researching this disease, the author will mention a virus possibly being the culprit.  If you research which viruses.........the really nasty one is the herpes.  It has been around forever.....the Greeks talked about it.  It really messes with our immune system.Hi Elliott: Wow, Elliott thank you so much...I am sorry however that it is PMR that brought you here...but it would be so helpful to find pool information and stories together to help us through this whole thing. Hello Everybody:

I have now been on the 20 mg dose of Prednisone for two weeks and seem to have settled into a fairly predictable pattern. I am now able to sleep fairly well, but by early morning have considerable stiffness/pain in the shoulders and upper arms, with some moderate pain, and less stiffness in the hips and thighs. A long hot shower helps loosen me up, but staying in one position, especially sitting, brings back the pain/stiffness until I move around for a few seconds. I take the Prednisone dose around 8:00 AM with breakfast, and by 9:30-10:00 AM things start to get better. By noon I am generally fairly pain free with almost no stiffness, and remain that way until I go to bed around 11:00 PM to midnight, when I can feel a slight return of pain in the shoudlers. To help reduce the return of pain/stiffness overnight, I take two 220 mg Naproxen tablets around 9:30-10:00 PM. The level of morning stiffness/pain seems to correlate somewhat with the level and type of activity during the day -- the more strenuous the activity, the more morning pain/stiffness. Weather permitting, I try to walk around 4 miles each day, usually taking about an hour. Today I will have my first CRP blood test since starting on the Prednisone, and in one week I have my next visit with the rheumatologist.

Everything I have read about taking Prednisone seems to stress that it should be taken in one dose in the morning, preferably with breakfast. The reason for this seems to be the belief that this correlates closely with the body's natural production cycle of corticosteroids so that taking it at this time will minimize the drastic effects (atrophy, shut-down of natural corticosteroid production, etc.) long-term Prednisone use can have on the adrenal glands. From reading all the posts on this forum it seems that my experience with the effects of Prednisone on symptom relief are not that unusual. Taking a single morning dose definitely relieves the symptoms, sometimes quite dramatically, when it kicks in within a couple of hours, but it does seem to wear off in the early morning hours. Many of you seem to have tried some form of split dosage, usually with the bulk taken in the morning, with a smaller dose in the evening to get through the night. I have tried in vain through exhaustive internet searches to find any reliable information of the efficacy of split dosage, mainly anecdotal information that seems to indicate it can help with alleviating early morning symptoms. There seems to have been no studies on the possible adverse effects of splitting the dose, mainly outright statements that it will make the effects on the adrenals worse. There is a new timed-release version of Prednisone being developed in Europe (Lodotra) that is taken at night so that it releases in the early morning. It is currently undergoing clinical trials in Europe. I am not sure of its status in the US.

When I see the rheumatologist next week I am assuming she will suggest lowering the dose. If she does not suggest it, I will, as I will have been on 20 mg for 3 weeks and would like to begin a slow taper. I will also ask her about splitting it, perhaps 2/3 morning, 1/3 evening, or something similar. So far, I have noticed only one possible side effect of the Prednisone, which is a persistent dry/tingly feeling in the mouth, primarily on the top of the tongue. I have a yellowish coating on part of the tongue, but am also experiencing a persistent post-nasal drip that I think is probably the result of early spring pollen. In the past when I have had this kind of coating it was usually from a cold/sore throat/mild allergy. At first I thought I might have the beginnings of oral thrush, but the coating is yellowish, not white, and does not have the "cottage cheese" appearance that appears to be the hallmark of thrush.

Thus far, I have not received any real comments on the PMR survey I posted last Monday. In addition to the forum and the PMR-GCA group in the UK I mentioned in a previous post, I have been in contact with two other groups:

1) PMR Fighters in the UK
2) National Medical Research Foundation -- http://www.nmrfoundation.com.

Both groups seemed interested in my survey. In fact, PMR Fighters has a questionnaire they send out to their members for collecting information on PMR, with considerable overlap with my survey. I also spoke at length with the founder of the NMR Foundation. She is quite active in trying to develop new support groups for PMR/GCA throughout the US and Canada, and seemed quite interested in the concept of a survey to collect useful statistics regarding PMR. Elliot, Hi Elliot
I just read your post and love the idea of bringing all the information together into some cohesive document. I am in my 3rd week of prednisone at 40 mg and I am similar to you in the morning and I am thinking of doing the 2/3 morning and 1/3 evening. Because of my condition, I was thinking you could add an area to your form that talks about other conditions and drugs that some PMR people may have or be taking. I have MS and take copaxone. I have been taking the copaxone for 7 years. I would like to see if there is any effect regarding cause and treatment of PMR by the MS or the copaxone. Again I plan to fill out your form and hopefully this will bump it to the top of the board.
Thanks again
CraigHi Elliot, Hi Craig, Wildflower, Donna:

Although I asked people to look at the survey and make suggestions, but not fill it out yet because it will probably change as a result of input from several groups, I have received 8 responses thus far, presumably from people at this forum. As mentioned in an earlier post on this thread, I have been in contact with other groups, most recently PMR Fighters in the UK and the National Medical Research Foundation, and they are in the process or reviewing the survey. PMR Fighters is allied with one of the few people (Bhaskar Dasgupta) actually conducting research on PMR.

Once the survey is finalized, I may ask those who have responded to either redo the survey (if it has changed significantly) or fill it out again, but only in newly added questions, and then indicate in the additional comments box at the end that this is what they did, and provide a date/time when they initially responded so that I can amalgamate the two responses. I do not want to lose the existing responses because many of you provided some extremely detailed and useful information in the additional comments box at the end.

I started splitting my dose a few days ago, 15mg in the AM, 5 mg in the PM. So far I have not noticed much difference in my morning stiffness/pain, which is still quite impressive. Most days, my back, hip, and thigh pain go away almost completely about 4 hours after the AM dose, but lately my shoulder pain never completely resolves, but does get much better within about 4 hours. I have noticed that my morning symptoms get worse if I have more than a glass of wine the previous day, or if I use my arms more than usual for things like housework.

I am waiting for the results of the aldolase and CK tests ordered by my rheumatologist, but expect them to be negative given that these are tests for myositis, where the primary symptom is muscle weakness rather than pain, and I do not have any muscle weakness.

I will post more when I hear back from the other PMR groups.
Thanks Elliott
I will wait to fill out the form until you give us the word. Also I would stress that anyone who is following this form who has PMR and by the grace of God gets over it before Elliott gets the survey ready, please check back and give us your input too. As the results from people who have gotten over the pmr are as, if not more inportant, as the ones who still have it.
Elliott, as for the glass of wine the day before, I am not giving that up. LOL

CraigI was recently diagnosed with PMR.  I was wondering if anyone else presented like I did.  I had swollen joints (mainly fingers, wrists, knees, and ankles) and some pitting edema in lower legs.  I was retaining about 10 pounds of fluid.  My ESR, CRP, and aldolase were elevated.  Blood work didn't support RA.  Because of the joints I had a very difficult time moving.  No muscle pain at all.  However, after starting on 20 mg of prednisone I started eliminating the extra fluid (gone in a week) and felt so much better and could move around.  My thighs do get swollen every day.  Again, I have never had any muscle pain even before prednisone.  My shoulders and hips have always been good.  I have only recently had a little stiffness in my neck, but no pain.  I am a 43 year old female.  I just am not sure if this diagnosis is correct.  I have only been dealing with this since early January (4 months).  Any thoughts?I am anxiously awaiting the finished questionaire.  I'm starting another reduction.  Going from 7mg to 6.5 mg.  Alternating the dosages, and so far, so good.  Still maintaing the low sugar and low salt diet.

 

Donna PA

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