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What Causes Neck Pain,headaches,fatigue Long With The Increased Inflammation?
Question: I was diagnosed with Polymyalgia Rheumatica in XXXXXXX 2012. I have been on 5-10mg of Prednisone for the past 2 years. This Feb I got whatever was going around that was termed as Bacterial/Viral with the bad cough. I recovered with antibiotics. I did have a break through PMR pain. When I was diagnosed I had a slightly elevated ESR and C reactive Protein. Over the past 2 months my ESR is 92 (<30) my C reactive Protein is 1.7 <.80 and white blood 18.8 Thousand/ul 3.8-10.8 MCH 26.7 (27-33) RDW 15.2% low vit D and B12. I had possible symptoms of GSA, and will have a biopsy next week. I have been on 40mg of Prednisone for a week. IF GSA is negative what are other possibilities, and is it worth further investigation. Oh, and I have a history of Histoplasmosis, which was treated with antifungal, but left necrotic lung tissue. I am a 53 year old female.
Brief Answer:
Lot more differential diagnosis are there.
Detailed Answer:
Hi,
I have gone though your query.
Tests for polymyalgia rheumatica has already done in your case, there are no other useful tests which can be done. I think you have mistakenly written GSA in place of G.C.A which is giant cell arteritis, for which biopsy is necessary.
You have not mentioned any history of -
-fever
-headache
-tenderness and sensitivity on the scalp
-jaw claudication (pain in jaw when chewing)
-tongue claudication (pain in tongue when chewing) and necrosis.
-Pain and stiffness (moderate to severe) in the neck, shoulders, and hips, which inhibits activity, especially in the morning/after sleeping.
-Fatigue and lack of appetite (possibly leading to weight loss) which are also indicative of polymyalgia rheumatica.
-reduced visual acuity (blurred vision)
-diplopia (double vision).
If G.C.A is found to be negative then you may have -
Dermatomyositis, Myopathy, Parkinson disease, Calcium pyrophosphate deposition disease, Late-onset ankylosing spondylitis, wegener granulomatosis etc, there is a long list of that.
Please clarify the term GSA so that I am better able to help you.
Waiting for your reply.
Thanks.
Dr.Singh.
Lot more differential diagnosis are there.
Detailed Answer:
Hi,
I have gone though your query.
Tests for polymyalgia rheumatica has already done in your case, there are no other useful tests which can be done. I think you have mistakenly written GSA in place of G.C.A which is giant cell arteritis, for which biopsy is necessary.
You have not mentioned any history of -
-fever
-headache
-tenderness and sensitivity on the scalp
-jaw claudication (pain in jaw when chewing)
-tongue claudication (pain in tongue when chewing) and necrosis.
-Pain and stiffness (moderate to severe) in the neck, shoulders, and hips, which inhibits activity, especially in the morning/after sleeping.
-Fatigue and lack of appetite (possibly leading to weight loss) which are also indicative of polymyalgia rheumatica.
-reduced visual acuity (blurred vision)
-diplopia (double vision).
If G.C.A is found to be negative then you may have -
Dermatomyositis, Myopathy, Parkinson disease, Calcium pyrophosphate deposition disease, Late-onset ankylosing spondylitis, wegener granulomatosis etc, there is a long list of that.
Please clarify the term GSA so that I am better able to help you.
Waiting for your reply.
Thanks.
Dr.Singh.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
My Apology,
I have had jaw pain, which I thought was from long time TMJ. neck pain and headaches, severe fatigue,Along with the increased inflammation, that is why I am getting the Biopsy for GCA. I have had weight loss of 20 pounds, fevers under 100, and stiffness. All of which I had when diagnosed with PMR.However, pain and stiffness is not as bad as it was when first diagnosed. I also have bone on bone arthritis in my left hip and right shoulder, so it is hard to tell sometimes, due to having bilateral pain that may be from compensating for arthritis. My main concern is the labs, and that I have developed something outside of PMR, that has not been identified, just concerned this is not a PMR "flare" . My SED rate was in the low 30's when diagnosed with PMR, and I know that one cannot diagnose on SED Rate alone. I have a history of Histoplasmosis as well.
I have had jaw pain, which I thought was from long time TMJ. neck pain and headaches, severe fatigue,Along with the increased inflammation, that is why I am getting the Biopsy for GCA. I have had weight loss of 20 pounds, fevers under 100, and stiffness. All of which I had when diagnosed with PMR.However, pain and stiffness is not as bad as it was when first diagnosed. I also have bone on bone arthritis in my left hip and right shoulder, so it is hard to tell sometimes, due to having bilateral pain that may be from compensating for arthritis. My main concern is the labs, and that I have developed something outside of PMR, that has not been identified, just concerned this is not a PMR "flare" . My SED rate was in the low 30's when diagnosed with PMR, and I know that one cannot diagnose on SED Rate alone. I have a history of Histoplasmosis as well.
Brief Answer:
Biopsy is most important.
Detailed Answer:
Hi,
Thanks for response.
I want to let you know that your most of symptoms match with PMR and most of the tests already done for PMR, biopsy is must for diagnosis to be made. You may send me the report of biopsy. If biopsy show vasculitis characterized by a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells, then the diagnosis is definitely G.C.A.
You are taking Prednisone, it may be the reason that your ESR is lower.
Other important tests you may have are urine tests that detect protein and red blood cells in the urine (not visible to the naked eye) and x-ray tests of the chest and sinuses which detect abnormalities resulting from lung and sinus inflammation, Antineutrophil cytoplasmic antibody (ANCA test) and liver function tests.
I hope you have got your answer.
You are welcome to ask any health related query.
Thanks.
Dr.Singh.
Biopsy is most important.
Detailed Answer:
Hi,
Thanks for response.
I want to let you know that your most of symptoms match with PMR and most of the tests already done for PMR, biopsy is must for diagnosis to be made. You may send me the report of biopsy. If biopsy show vasculitis characterized by a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells, then the diagnosis is definitely G.C.A.
You are taking Prednisone, it may be the reason that your ESR is lower.
Other important tests you may have are urine tests that detect protein and red blood cells in the urine (not visible to the naked eye) and x-ray tests of the chest and sinuses which detect abnormalities resulting from lung and sinus inflammation, Antineutrophil cytoplasmic antibody (ANCA test) and liver function tests.
I hope you have got your answer.
You are welcome to ask any health related query.
Thanks.
Dr.Singh.
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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