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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes fatigue, depression, anxiety and dizziness when diagnosed with PMR?

Answered by
Dr.
Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 748 Questions

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Posted on Mon, 29 Aug 2016 in Lupus
Question: I don't know where to start. I was diagnosed with PMR in 5/2012, however prednisone never brought my inflammation levels down to normal. I'm sick EVERYDAY. I've tried everything; Rx, supplements. I am not living, I am existing. No one should have to live like this. I've had CAT scan done on lungs, abdomen, pelvis. All they found was very small nodules on my lungs and said to retest in 6-12 months. I've had colonoscopy done; it was fine other than I have an extra long colon. I had an Interstem Implant put in 5/2016 for bowel incontinence. I am a white female; 62 yrs. old. I have fatigue, pain, depression, anxiety, dizziness (sometimes). I am currently seeing a Rheumatologist and my PCP. I also have rapid heart rate from time to time.
doctor
Answered by Dr. Naval Mendiratta 1 hour later
Brief Answer:
Is it pmr

Detailed Answer:
good evening

thank you for writing on health care magic

Well, I have gone through your history and would. like. to know a few more details as it is very unusual for PMR to not respond to steroid

1. Where exactly is the pain located. is it in shoulders or hip or whole body

2. do you experience good sleep or is it disturbed...and how do you feel in the mornings..

3. any History Of recent mood changes like short tempered or irritability

4. any hHistory Of forgetfullness which has increased recently..

5. any time you have had joint swelling or oral ulcers

6. how much was your esr and crp last checked

Do let me know these queries. we need to look out for other causes since you havnt had much improvement with steroid and all other work up is negative
.

await your reply.

regards
Dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Naval Mendiratta 15 hours later
Dr. Naval: Thank you for your prompt response. Here are the answers to your questions:
1. My pain is not just in my shoulders and hips; it is all over, not all the time, but at one time or another I have pain from my head to my toes. I have pain particularly in my hands when I move them. I have been tested for Rheumatoid Arthritis, which was negative.
2. I have problems sleeping; I have laid in bed for hours and still no sleep. Currently I take 10 mg. Melatonin, 1 mg. Klonopin and a supplement called Taurine to get to sleep. But then when I wake up the next morning between 8-9 I watch TV for about 90 minutes, then I am tired and usually go back to sleep until at least noon. If I get up at 8-9 I fall asleep in my recliner.
3. Mood changes are not real bad, but I am irritable from time to time. It doesn't take much stress to get me upset. Maybe, that's just my age; I don't know.
4. My forgetfulness is bad, especially my short term memory. I am currently taking a supplement for that too, which seems to be helping some. I lost a sister to Alzheimer's at age 64 (13 yrs. ago).
5. I haven't noticed any swelling; however at times my feet feel "tight." I do have oral blisters from time to time.
6. Results of my last ESR was 58; it was 87 in 3/2016, then I started supplements in 4/2016 and it dropped to 58. My CRP was 1.6 in 3/2016; I can't find my most recent result for it.
I hope this helps. I look forward to hearing from you. By the way my next appt. with my Rheumatologist is Aug. 15th.


Dr. Naval: I failed to answer how I feel when I get up in the mornings. I feel awful. It takes about 2 hours (or less) for me to get "going." My husband is nice enough to fix breakfast for me.

XXXX
doctor
Answered by Dr. Naval Mendiratta 10 hours later
Brief Answer:
Is it PMR

Detailed Answer:
GOod evening XXXXXXX

Well, as per your history it doesnt fit very well into PMR.. Maybe PMR was present initially which has responded well to steroids. But the current symptoms you are having look more of Chronic Pain Syndrome.. Moreoever, if it was an inflammatory condition the response to steroids would have happened by now..

So I feel there is something else we are looking at...

I would like you to read about this diagnosis called Fibromyalgia( Decreased sleep, fatigue, irritability, widespread pain, forgetfullness ) all fit in with it...

www.Rheumatology.org--> patient information--> Fibromyalgia...

DO let me know if your symptoms match...

PS: You are one lucky person to have your husband fix your breakfast :)...I am sure if my wife reads it, she will ask me to learn something from it

Await your reply

Regards
Dr Naval


Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Naval Mendiratta 10 hours later
Thank you so much. My Rheumatologist did mention fibromyalgia to me, that I may possibly have it or have both. Is the treatment the same? I am really afraid to take prednisone because of the terrible side affects. I will check into Fibro and will be in touch. Again, thank you. I know I am very blessed to have such a good husband. We've been married 28 years. Where are you located?

XXXX

I read the website you mentioned about Fibro. I do have all of the symptoms mentioned. One question I do have. It said Fibro does not cause inflammation. If that be true then why is my sedimentation rate so high. It has been as high as
87. This is confusing to me.
doctor
Answered by Dr. Naval Mendiratta 26 hours later
Brief Answer:
PMR with Fibromyalgia

Detailed Answer:
Good evening XXXXXXX

Sorry for the delayed reply.. Had a presentation in a conference

Well, the fibromyalgia does have some triggering factor and that could have been due to PMR. That may be the reason you have high ESR. ESR does take 4-6 weeks to come down to normal even if the disease is silent. But yes, the more sensitive test is the response to steroids in PMR...If you are not responding to steroids, it is something else going on...

To confirm PMR activity or not, you can ask your rheumatologist if he can run an ultrasound of the shoulder and pelvic area. Ultrasound can pick up active inflammation. If clear, I think we should treat on line of fibromyalgia and repeat ESR after a couple of months to see the fall....MEanwhile keep minimum possible dose of steroids...

Hope the information was useful. Do let me know for more queries

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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