Polymyalgia rheumatica is an autoimmune disease

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June 28, 2019 - 5:05 PM

Dear Dr. Roach: I was recently worked up for an autoimmune disease that now seems to be osteoarthritis. I was placed on 10 mg of prednisone for 14 days with amazing relief from my painful shoulder and arms. I am severely allergic to aspirin and do not want to take opioids. The physician has ordered prednisone 2.5-5 mg daily to control symptoms. Is it safe to take this low dose of prednisone daily for pain control? — M.O.

Answer: It sounds to me that the physician may not have communicated as effectively as I might have hoped. Osteoarthritis, although a widespread cause of joint pain, is not an autoimmune disease, and it is not treated with prednisone. Instead, it sounds very much like you may have polymyalgia rheumatica.

PMR is found in women more often than in men and rarely in people under 50, most commonly in a person’s 70s. Hallmark symptoms are joint pain, especially of the shoulders and upper arms, that is much worse in the morning. PMR also is very sensitive to prednisone 10-20 mg: If it doesn’t respond dramatically to those kinds of doses, it probably isn’t PMR. A laboratory finding, the erythrocyte sedimentation rate, is almost always very elevated (92-94%) in PMR. A different blood test for inflammation, C-reactive protein, is abnormal in 99% of people with the condition.

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