Aa
Is this probably PMR?
A little knowledge is a dangerous thing and I hope you don't mind my asking for a second opinion here?
My partner has suffered months of sleep deprivation and pain in a line from her ears to the base of her spine, plus loss of a stone in weight and depression. This has finally been diagnosed as possibly polymyalgia rheumatica.
This is a relief in itself from the point of view of allaying fears of something really sinister and life threatening but, although after two days of steroids have shown slight improvement so far, she is not keen on a lengthy spell of steroid treatment. Given the extract from her consultant's letter to her own doctor shown below, I hope you don't mind us asking whether a) this would definitely appear to be PMR and b) whether there would be any long-term alternative to steroid use?
Extract as follows:-
"The alkaline phosphotase enzyme remains elevated at 154u/L, but the gamma GT enzyme is completely normal at 15 units. In other words this suggests that the alk. phos. is not of bile duct origin. The C reactive protein has jumped from 27 up to 70mg/L and the ESR is also elevated at 37mm/hr. In addition there is a slight rise in the platelet count at 462, but with normal haemoglobin, white cells and red cell indices. The biochemical profile shows normal calcium. Isotope bone scan shows no evidence of arthritis. There is a small focus of uptake on the posterior part of the 11th rib on the left and the radiologist thinks that this probably relates to previous trauma. In addition there is a small area of increased uptake in the lower part of the cervical spine on the right which the radiologist thinks is due to some degenerative change.
I do not think there is any alternative but to assume that there is possible polymyalgia rheumatica and to give her corticosteroids. I would recommend that she have Prednisolone EC 15mg each morning. If she does have PMR, then within 2 or 3 days she should notice a big difference, and larger doses of steroids are rarely required for PMR."
My partner has suffered months of sleep deprivation and pain in a line from her ears to the base of her spine, plus loss of a stone in weight and depression. This has finally been diagnosed as possibly polymyalgia rheumatica.
This is a relief in itself from the point of view of allaying fears of something really sinister and life threatening but, although after two days of steroids have shown slight improvement so far, she is not keen on a lengthy spell of steroid treatment. Given the extract from her consultant's letter to her own doctor shown below, I hope you don't mind us asking whether a) this would definitely appear to be PMR and b) whether there would be any long-term alternative to steroid use?
Extract as follows:-
"The alkaline phosphotase enzyme remains elevated at 154u/L, but the gamma GT enzyme is completely normal at 15 units. In other words this suggests that the alk. phos. is not of bile duct origin. The C reactive protein has jumped from 27 up to 70mg/L and the ESR is also elevated at 37mm/hr. In addition there is a slight rise in the platelet count at 462, but with normal haemoglobin, white cells and red cell indices. The biochemical profile shows normal calcium. Isotope bone scan shows no evidence of arthritis. There is a small focus of uptake on the posterior part of the 11th rib on the left and the radiologist thinks that this probably relates to previous trauma. In addition there is a small area of increased uptake in the lower part of the cervical spine on the right which the radiologist thinks is due to some degenerative change.
I do not think there is any alternative but to assume that there is possible polymyalgia rheumatica and to give her corticosteroids. I would recommend that she have Prednisolone EC 15mg each morning. If she does have PMR, then within 2 or 3 days she should notice a big difference, and larger doses of steroids are rarely required for PMR."
Here is some information about Non-hodkins Lymphoma:
Diagnosis and Staging
Doctors do a test called a biopsy to find out if a patient has NHL. To do the biopsy, a surgeon removes an enlarged lymph node and a pathologist studies the lymph node under a microscope to see if the patient has NHL. Sometimes the biopsy is done to examine cells from a tumor or the skin.
The doctor may do a cytogenetic analysis of the cells from the biopsy. This is a lab test that looks to see if there are changes in the chromosomes of the NHL cells.
Blood tests are done to look for low counts of red cells, low white cells or platelets. Bone marrow tests are done to look for NHL cells in the marrow.
A lab test called immunophenotyping can also be used to find out if the patient's NHL cells are B cells or T cells.
These lab tests help the doctor to diagnose the patient's type of NHL and the best way to treat the patient's disease.
Imaging tests are done to create pictures of the chest and abdomen - and see if there are lymphoma masses in the deep lymph nodes, liver, spleen or lungs.
Examples of imaging tests are:
• CT scans (Computed Tomography)
• MRI (Magnetic Resonance Imaging)
• PET scans (Positron Emission Tomography)
The next step after the doctor makes a diagnosis of NHL is to find out how widespread the disease is. This is called "staging." Blood, marrow and imaging tests also help the doctor to see how advanced the disease is. The doctor looks for the signs below to identify the stage:
• The number of lymph nodes that are affected
• Where the affected lymph nodes are (for example, in the abdomen or the chest or both parts of the body)
• Whether any cancer cells are in other parts of the body besides the lymph nodes or lymphatic system, such as the lungs or liver
The biggest issue it seems now, is determining what has caused the growth. Do they have any idea where it may have spread from? Have they done a PET scan? It's my understanding that would show any other enlarged areas.
As for the US pushing meds for profit... that is a can of worms I'm not sure I'm ready to open! I'll just say, I was recently diagnosed by a neurologist with Small Fiber Neuropathy. His nurse called, gave me the diagnosis and told me the doctor wanted to start a once monthly IVIG treatment (plasma) and her number for any questions I may have. When I called her the next day, she was all nice and accomodating, until she found I had no insurance and couldn't afford the $2000.00 per month treatment. She even made a comment along the lines that I should be greatful it wasn't cancer! I've been waiting for her to send me test results for over 2 weeks now. She won't even return a phone call. That should give you an idea on my thoughts on the subject.
Diagnosis and Staging
Doctors do a test called a biopsy to find out if a patient has NHL. To do the biopsy, a surgeon removes an enlarged lymph node and a pathologist studies the lymph node under a microscope to see if the patient has NHL. Sometimes the biopsy is done to examine cells from a tumor or the skin.
The doctor may do a cytogenetic analysis of the cells from the biopsy. This is a lab test that looks to see if there are changes in the chromosomes of the NHL cells.
Blood tests are done to look for low counts of red cells, low white cells or platelets. Bone marrow tests are done to look for NHL cells in the marrow.
A lab test called immunophenotyping can also be used to find out if the patient's NHL cells are B cells or T cells.
These lab tests help the doctor to diagnose the patient's type of NHL and the best way to treat the patient's disease.
Imaging tests are done to create pictures of the chest and abdomen - and see if there are lymphoma masses in the deep lymph nodes, liver, spleen or lungs.
Examples of imaging tests are:
• CT scans (Computed Tomography)
• MRI (Magnetic Resonance Imaging)
• PET scans (Positron Emission Tomography)
The next step after the doctor makes a diagnosis of NHL is to find out how widespread the disease is. This is called "staging." Blood, marrow and imaging tests also help the doctor to see how advanced the disease is. The doctor looks for the signs below to identify the stage:
• The number of lymph nodes that are affected
• Where the affected lymph nodes are (for example, in the abdomen or the chest or both parts of the body)
• Whether any cancer cells are in other parts of the body besides the lymph nodes or lymphatic system, such as the lungs or liver
The biggest issue it seems now, is determining what has caused the growth. Do they have any idea where it may have spread from? Have they done a PET scan? It's my understanding that would show any other enlarged areas.
As for the US pushing meds for profit... that is a can of worms I'm not sure I'm ready to open! I'll just say, I was recently diagnosed by a neurologist with Small Fiber Neuropathy. His nurse called, gave me the diagnosis and told me the doctor wanted to start a once monthly IVIG treatment (plasma) and her number for any questions I may have. When I called her the next day, she was all nice and accomodating, until she found I had no insurance and couldn't afford the $2000.00 per month treatment. She even made a comment along the lines that I should be greatful it wasn't cancer! I've been waiting for her to send me test results for over 2 weeks now. She won't even return a phone call. That should give you an idea on my thoughts on the subject.
Thank you again for your words of encouragement and advice.
We're back in limbo-land again now after visiting my partner's surgeon last night. He revealed the CT scan shows a large 3.15 inch 'mass' (80mm in metric) around her pancreas which he believes is malignant.
His feeling is that it is unusually large for a PC and that there's a small chance that it could either be a secondary from the primary in the same area or even a lymphoma ... which, I gather could be dealt with a little better? Either way, he now needs to do an endoscopy and take a biopsy of the tissue to find out what it is.
Obviously, with a mass this size in the area it is, he has ruled out surgery and I guess any treatment would revolve around chemo only? I gather they do not routinely use radiotherapy here in the UK because they simply don't think it is of much benefit with PC.
So ... it looks like my partner's hopes and aspirations lie solely with the possibility that one of the combinations of drugs may retard this horrible growth.
I'm sure there would be a lot of debate (and I'd love to evaluate all of it for obvious reasons) over his thinking here: - when I asked him why only two combinations of drugs were generally used in the UK, whilst there were often three in the USA, his thoughts were that, in the UK they're always trying to save money on drugs because they're state-funded, whilst in the USA, everyone's always trying to get you to use more for commercial gain.
Personally, I don't give a damn about politics or business - this comes down to wanting to save my beautiful lady any which way I can. So ... back to Square One: can I invite comment from you lovely people once again please?
(I'm going to start posting in the cancer areas of this and other sites because time is obviously of the essence now.)
We're back in limbo-land again now after visiting my partner's surgeon last night. He revealed the CT scan shows a large 3.15 inch 'mass' (80mm in metric) around her pancreas which he believes is malignant.
His feeling is that it is unusually large for a PC and that there's a small chance that it could either be a secondary from the primary in the same area or even a lymphoma ... which, I gather could be dealt with a little better? Either way, he now needs to do an endoscopy and take a biopsy of the tissue to find out what it is.
Obviously, with a mass this size in the area it is, he has ruled out surgery and I guess any treatment would revolve around chemo only? I gather they do not routinely use radiotherapy here in the UK because they simply don't think it is of much benefit with PC.
So ... it looks like my partner's hopes and aspirations lie solely with the possibility that one of the combinations of drugs may retard this horrible growth.
I'm sure there would be a lot of debate (and I'd love to evaluate all of it for obvious reasons) over his thinking here: - when I asked him why only two combinations of drugs were generally used in the UK, whilst there were often three in the USA, his thoughts were that, in the UK they're always trying to save money on drugs because they're state-funded, whilst in the USA, everyone's always trying to get you to use more for commercial gain.
Personally, I don't give a damn about politics or business - this comes down to wanting to save my beautiful lady any which way I can. So ... back to Square One: can I invite comment from you lovely people once again please?
(I'm going to start posting in the cancer areas of this and other sites because time is obviously of the essence now.)
I'm a bit educated in the "dross" in dealing with some cancers, and I've learned how to research, so if you ever need "med speak" translated, you are more then welcome to post here or even PM me. I will do whatever I can. If I can't find an answer, I'll be upfront and tell you.
You are both in my thoughts. Sending warm hugs from Ohio!
You are both in my thoughts. Sending warm hugs from Ohio!
Many thanks for all of this - I hope you're aware of just how much valuable time can be bought by relatives (and, obviously, the patients themselves) by people such as yourself cutting through all the 'dross' and false promises that surround such things. It will never cease to depress me that fellow human beings can seek to profit from others' misery. By the same token people such as yourself who simply take the time to be compassionate stand out like beacons. A lesson and example to us all.
I have returned from a few days away and wanted to check on you. I am so sorry to read what you are up against. I have an uncle in chemo for this very condition right now. He had the whipple procedure a few months ago. I will keep you both in my prayers and hope for the best possible outcome. I encourage you to visit the cancer forum on medhelp if you have not already been there. There you will find the support and information you need to help you through this tough time. We will, of course, be here for you, too.
Thank you so much. I think we're in that 'Limbo Land' at the moment and, although she and I know that our battle must start soon, it takes a while for it all to sink in (as I'm sure you know) ... and recognize that it's now a whole new ball game. Although I have some confidence in the people here, they're now so overwhelmed with work that I think, with the best will in the world, people owe it themselves and their loved ones to share information with those in other areas. Our 'special relationship' owes more to this sort of feeling, I think, than anything the politicians can dream up.
Here is what I found so far.
http://en.wikipedia.org/wiki/Pancreatic_cancer
It does mention about treatment, that the US supports radiation therapy while Europe does not...
I will look into more.
http://en.wikipedia.org/wiki/Pancreatic_cancer
It does mention about treatment, that the US supports radiation therapy while Europe does not...
I will look into more.
Oh Mark, I'm so sorry to hear this! I'm also the community leader in the leukemia & lymphoma community here, so I will look into things.
You will both be in my thoughts!
You will both be in my thoughts!
No easy way to put this!
At 4.40 yesterday afternoon, I accompanied my partner to the specialist to be told that the latest CT scan had discovered pancreatic cancer - with all that it entailed. As you can imagine, this is the news that we all dread and yet, somehow always expect. Our immediate task is a first appointment with an oncologist on Wednesday next. I have to say that I am not impressed with reports of cancer survivability rates here in the UK and would value ANY advice as to where I can go or what I can do to save my partner's life. My grateful thanks for all you've done so far.
At 4.40 yesterday afternoon, I accompanied my partner to the specialist to be told that the latest CT scan had discovered pancreatic cancer - with all that it entailed. As you can imagine, this is the news that we all dread and yet, somehow always expect. Our immediate task is a first appointment with an oncologist on Wednesday next. I have to say that I am not impressed with reports of cancer survivability rates here in the UK and would value ANY advice as to where I can go or what I can do to save my partner's life. My grateful thanks for all you've done so far.
Thanks for keeping us updated!
From what I can see, her levels are slowly dropping:
WBCs - 17.63 to 15.88
Platelet Count - 507 to 486
Neutrophil Count - 14.71 to 13.68
Serum alkaline phosphatise - 154 to 127
Erythrocyte sedimentation rate - 37 to 36
Plasma C Reactive Protein - 70 to 55
My understanding is, if it were a bone cancer, her white counts would be increasing, while her RBC and platelets dropped. ESR and CRP are inflammation markers, and those are also decreasing. CRP usually decreases faster than ESR, which seems to be the case here.
It's possible there is more then one thing going on as well. Have they run any tests for autoimmune disorders? Such as ANA and the various patterns? Those would be: SM Antibody, RNP Antibody, SSA Antibody, SSB Antibody, Centromere, Scleroderma IgG AB, Jo1 Antibody, Ribosomal RNP, Chromatin Antibody, Rheumatiod Factor to name a few.
Please keep us posted, and any more questions fire away! We'll do our best!
From what I can see, her levels are slowly dropping:
WBCs - 17.63 to 15.88
Platelet Count - 507 to 486
Neutrophil Count - 14.71 to 13.68
Serum alkaline phosphatise - 154 to 127
Erythrocyte sedimentation rate - 37 to 36
Plasma C Reactive Protein - 70 to 55
My understanding is, if it were a bone cancer, her white counts would be increasing, while her RBC and platelets dropped. ESR and CRP are inflammation markers, and those are also decreasing. CRP usually decreases faster than ESR, which seems to be the case here.
It's possible there is more then one thing going on as well. Have they run any tests for autoimmune disorders? Such as ANA and the various patterns? Those would be: SM Antibody, RNP Antibody, SSA Antibody, SSB Antibody, Centromere, Scleroderma IgG AB, Jo1 Antibody, Ribosomal RNP, Chromatin Antibody, Rheumatiod Factor to name a few.
Please keep us posted, and any more questions fire away! We'll do our best!
As promised, the latest set of blood results which coincided with my partner's first appointment with the rheumatologist since being started on steroids. He agreed that there was almost certainly not a PMR element to her illness now and is weaning her off the steroids. At the same time, he has ordered a scan (CAT?) of her middle/lower intestinal area in order to investigate whether there is a 'blockage' of some kind ... especially in view of the weight loss (some 20lbs. or so at this time). He does not feel that there is a probability of viral or bacterial infection. He agrees that, as a rheumatologist, it is starting to 'leave his area' but also feels that he is qualified enough to advance investigations to the next stage.
Description Val. Unit Ab. Range
Serum TSH level 1 mu/L 0.30—5.00
Serum total bilirubin level 6 umol/L <17
Serum alkaline phosphatise 127 iu/L ! 25—120
ALT/SGPT serum level 14 iu/L <40
Serum gamma GT level 18 iu/L 60
Faecal occult blood test ©
Text : Negative
Plasma C Reactive Protein 55 mg/L ! <5.0
Mean Corpuscular Volume (MCV) 87.6 fL 75.0—100
Erythrocyte sedimentation rate 36 mm/h ! <10
Total white cell count 15.88 10*9/L ! 4.00—11.00
Neutrophil count 13.68 10*9/L ! 1.00—7.50
Kosinophil count 0.11 10*9/L 0.04—0.40
Basophil count 0.02 10*9/L <0.10
Lymphocyte count 1.42 10*9/L 1.00—4.00
Monocyte count 0.53 10*9/L 0.20—1.50
Platelet count 486 10*9/L 150—600
Haemoglobin estimation 132 g/L 115—165
Packed cell volume 0.42 Ratio 0.20—0.51
Red blood cell (RBC) count 4.77 10*12/L 3.80—5.80
Mean corpusc. Haemoglobin (MCH) 27.6 pg 26.0—35.0
Description Val. Unit Ab. Range
Serum TSH level 1 mu/L 0.30—5.00
Serum total bilirubin level 6 umol/L <17
Serum alkaline phosphatise 127 iu/L ! 25—120
ALT/SGPT serum level 14 iu/L <40
Serum gamma GT level 18 iu/L 60
Faecal occult blood test ©
Text : Negative
Plasma C Reactive Protein 55 mg/L ! <5.0
Mean Corpuscular Volume (MCV) 87.6 fL 75.0—100
Erythrocyte sedimentation rate 36 mm/h ! <10
Total white cell count 15.88 10*9/L ! 4.00—11.00
Neutrophil count 13.68 10*9/L ! 1.00—7.50
Kosinophil count 0.11 10*9/L 0.04—0.40
Basophil count 0.02 10*9/L <0.10
Lymphocyte count 1.42 10*9/L 1.00—4.00
Monocyte count 0.53 10*9/L 0.20—1.50
Platelet count 486 10*9/L 150—600
Haemoglobin estimation 132 g/L 115—165
Packed cell volume 0.42 Ratio 0.20—0.51
Red blood cell (RBC) count 4.77 10*12/L 3.80—5.80
Mean corpusc. Haemoglobin (MCH) 27.6 pg 26.0—35.0
Many thanks - yet again - to all of you at MedHelp. Like everyone else, I guess, we get these issues in fits and starts and you really have been so helpful.
I will print your comments and suggestions off and get my partner to remember them when she next sees her rheumatologist. Will get back to you again here when we have some more information.
I will print your comments and suggestions off and get my partner to remember them when she next sees her rheumatologist. Will get back to you again here when we have some more information.
txsilver will be off line for a few days so I will attempt to help answer some of this.
Your figures are fine, totally readable.
One of the causes of elevated Neutrophils is prednisone... From reading previous posts on this, I see she was taking them for a while, so that could be all that was. In leukemia, one would see reduced RBC along with the elevated WBC.
It sounds like it could be a bad infection, either bacterial or viral, that would be the cause of the elevated white count and the diarrhea, and the pain in her back could be caused by the degenerative changes. The pain she describes sounds a lot like nerve pain. You may want to consider a neurologist. ( I have OA of the low back and small fiber neuropathy - I know that pain) DId they run CT scan or MRI? Uptake I would assume CT scan. An MRI may give a clearer picture on possible stenosis in her cervical and thoracic region. If it is spinal compression, that MIGHT cause digestive issues too, depending on what nerves are effected.
Let us know what her other tests and results are. This may give us a clearer picture and allow us to give better suggestions.
Your figures are fine, totally readable.
One of the causes of elevated Neutrophils is prednisone... From reading previous posts on this, I see she was taking them for a while, so that could be all that was. In leukemia, one would see reduced RBC along with the elevated WBC.
It sounds like it could be a bad infection, either bacterial or viral, that would be the cause of the elevated white count and the diarrhea, and the pain in her back could be caused by the degenerative changes. The pain she describes sounds a lot like nerve pain. You may want to consider a neurologist. ( I have OA of the low back and small fiber neuropathy - I know that pain) DId they run CT scan or MRI? Uptake I would assume CT scan. An MRI may give a clearer picture on possible stenosis in her cervical and thoracic region. If it is spinal compression, that MIGHT cause digestive issues too, depending on what nerves are effected.
Let us know what her other tests and results are. This may give us a clearer picture and allow us to give better suggestions.
My apologies for the jumble of figures. I carefully aligned everything in the draft box and it ended up like this when I posted it. Please let me know if I need to do it again.
Many thanks indeed for your interest in this.
No ... the local practitioner is not a rheumatologist but the report extract shown in my first post here is from one we have seen. It really is a strange and frustrating one and, of course, with the absence of information (the specialist is on vacation at this time), her brain has been working overtime with thoughts of 'myeloid leukaemia' and all sorts of other life-threatening illnesses ... tho' the specialist has already told her that he does not believe that it will transpire to be the latter.
Her own practitioner has now ordered two blood tests whilst we await the specialist's return. The first was last week and I have attached the relevant values as follows:-
Abn Value/Units Range Stat
Volume of Specimen Collected: N/A
Specimen Desc. : BLOOD (FPH)
Erythrocyte sedimentation rate HI 16 mm/h (0-10)
FBC
HB 131 g/L (115 -165)
WBCs HI 17.63 10*9/L (4.0—11.00
Platelet Count 507 10*9/L (150—600)
Packed Cell Volume 0.40 Ratio (0.20—0.51)
MCV 87.1 fL (75.0—100.0)
MCH 28.2 pg (26.0—35.0)
RBCs 4.64 10*12/L (3.80—5.80)
Neutrophil Count HI 14.71 10*9/L (1.00—7.50)
Lymphocyte Count 1.74 10*9/L (1.00—4.00)
Monocyte Count 0.89 10*9/L (0.20—1.50)
Eosinophil Count 0.10 10*9/L (0.04—0.40)
Basophil Count 0.02 10*9/L (0.00—0.10)
Another blood test is scheduled for tomorrow - although I have no idea what that one will be for. I am truly very grateful for your time over this.
No ... the local practitioner is not a rheumatologist but the report extract shown in my first post here is from one we have seen. It really is a strange and frustrating one and, of course, with the absence of information (the specialist is on vacation at this time), her brain has been working overtime with thoughts of 'myeloid leukaemia' and all sorts of other life-threatening illnesses ... tho' the specialist has already told her that he does not believe that it will transpire to be the latter.
Her own practitioner has now ordered two blood tests whilst we await the specialist's return. The first was last week and I have attached the relevant values as follows:-
Abn Value/Units Range Stat
Volume of Specimen Collected: N/A
Specimen Desc. : BLOOD (FPH)
Erythrocyte sedimentation rate HI 16 mm/h (0-10)
FBC
HB 131 g/L (115 -165)
WBCs HI 17.63 10*9/L (4.0—11.00
Platelet Count 507 10*9/L (150—600)
Packed Cell Volume 0.40 Ratio (0.20—0.51)
MCV 87.1 fL (75.0—100.0)
MCH 28.2 pg (26.0—35.0)
RBCs 4.64 10*12/L (3.80—5.80)
Neutrophil Count HI 14.71 10*9/L (1.00—7.50)
Lymphocyte Count 1.74 10*9/L (1.00—4.00)
Monocyte Count 0.89 10*9/L (0.20—1.50)
Eosinophil Count 0.10 10*9/L (0.04—0.40)
Basophil Count 0.02 10*9/L (0.00—0.10)
Another blood test is scheduled for tomorrow - although I have no idea what that one will be for. I am truly very grateful for your time over this.
Is your local practioner a rheumatologist? If not, I think it is time to get to a rheumatologist to have this investigated further. Because the steroids did not provide relief in a matter of days, I think the diagnosis of PMR can be ruled out. Please keep us posted on progress, symptoms and we will do what we can to help.
Well, two weeks into the steroid treatment and no noticeable improvement. We've just been back to see our local practitioner and he's trying her on Arthrotec 50 (diclofenac sodium?). Although we'll see just how she gets on with these she continues not to get any sleep; still has chronic diarrhea ... and says the pain in her back feels more like the nerve endings are on fire. If anyone's got any ideas out there as to what else this could be, we'd be grateful for the thoughts - however unpalatable they may be.
I can completely relate to the relief of a diagnosis - to know what it is and get a treatment plan is a huge event. I remember celebrating - wooohoo! LOL
From what I have read, corticosteroids are generally used to get this under control and usually provide relief in a day or 2. Several articles also indicated that if there was no relief in a few days then the diagnosis should be reconsidered. The treatment is tapered to a low dose and maintained for 2-4 years. The only other medicine I saw used as a standard treatment were NSAIDs.
The treatments for these conditions always come with side effects and concerns. It is important to evaluate all the ways that the disease affects our lives and weigh the pros and cons of the treatment.
Keep in touch, let us know what you two decide to do and how it works out!
From what I have read, corticosteroids are generally used to get this under control and usually provide relief in a day or 2. Several articles also indicated that if there was no relief in a few days then the diagnosis should be reconsidered. The treatment is tapered to a low dose and maintained for 2-4 years. The only other medicine I saw used as a standard treatment were NSAIDs.
The treatments for these conditions always come with side effects and concerns. It is important to evaluate all the ways that the disease affects our lives and weigh the pros and cons of the treatment.
Keep in touch, let us know what you two decide to do and how it works out!
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