7 December: Q&A with Dr Michael Martin

Please could you tell me if fibromyalgia is similar to polymyalgia rheumatica? I take Predisilone for polymyalgia which started eight years ago. I am 88 years old. Sometimes the problem clears up for a while, then returns. Please could you advise?

Dr Mike Martin, Consultant Rheumatologist, Spire Leeds Hospital

Your question demonstrates that the terminology used by doctors is often confusing for patients. 

Fibromyalgia is a condition characterised by aches and pains, generally unrelated to inflammation,  and it will not respond to treatment with steroids such as Prednisolone. 

Polymyalgia rheumatica (PMR), on the other hand, is a recognised inflammatory condition and invariably will get better with treatment by steroids. 

Prednisolone prescribed for PMR can usually be withdrawn after a limited treatment period. In some cases, however, it may take as long as two years for symptoms to settle.

However, for some people, symptoms do return and relapsing PMR is a recognised disease.    It will usually respond each time to a short course of steroids and only a few patients need life-long treatment. In your case, one explanation for continued symptoms may relate to reduced natural cortisol (steroid) production by the adrenal glands, and these circumstances may require long-term replacement therapy. 

I suggest you discuss these issues with your own GP as they may require further investigation.

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