Based on your symptoms, the examination findings, and blood test results, you have been diagnosed with a condition called Polymyalgia Rheumatica (PMR).

You can find useful information about this disease at this address:

https://patient.info/bones-joints-muscles/polymyalgia-rheumatica-leaflet

The treatment for this disease takes a long time, usually 1-2 years

Please do not stop any of your current medications

Summary Management Plan (You will find below detailed recommendations/instructions on how to take medication)

1. Start PREDNISOLONE.
2. Start ALENDRONIC ACID
3. Start tablets of VITAMIN D and CALCIUM
4. Start LANSOPRAZOLE
5. Eat as little salt as possible
6. Check your blood pressure every 6 months
7. Have a blood test every 6 months to check if you develop diabetes
8. Have regular consultations for review
9. What you should do when you feel pain as you felt before you started the treatment with PREDNISOLONE

Patient GP Management Plan: detailed explanations

1. Start medication PREDNISOLONE. Please be aware that this is a STEROID medication.
You may experience side effects over time.  The main side effects are osteoporosis, acid reflux/heartburn/water retention, and diabetes.
I will prescribe medication and recommend ways you can prevent these side effects.
You can find helpful information about Oral Steroids  at this website: https://patient.info/treatment-medication/steroids/oral-steroids
How to take PREDNISOLONE:
- You should take 3 tablets each morning, making 15 mg for 3 weeks (weeks 1, 2, 3)
- You should take 12.5 mg each morning for the next 3 weeks (weeks 4,5,6). You should take 2 tablets of PREDNISOLONE 5 mg and 1 tablet of PREDNISOLONE 2.5 mg
- You should take 10 mg each morning for the next for 5 weeks. You should take 2 tablets or PREDNISOLONE 5 mg - making 10 mg (week 7, 8, 9, 10, 11)
- Starting from week 12, you should reduce PREDNISOLONE by 1 mg every 4-8 weeks.
- Do not take any medication over the counter without consulting your GP.
2. I recommend you start a new medication to prevent you from having OSTEOPOROSIS. This disease is a medical condition in which the bones become brittle and fragile.
You will be at high risk of developing this disease because you´ll be on high doses of PREDNISOLONE for a while.
This medication, needed to prevent osteoporosis, is ALENDRONIC ACID. 
Do not stop any of your medication when you start this new medication. 
Take this medication once a week (on the same day every week). Please take it first thing in the morning on an empty stomach with a large glass of tap water.
Do not take ALENDRONIC ACID with tea, coffee, juice, squash or even bottled water. It will not be adequately absorbed and will not be effective in protecting your bones. Please read the medication prospect carefully before you start taking it.
If you have any side effects (mainly acid reflux/heartburn or swallowing problems), please stop it and speak to your GP. Please come to discuss with a nurse if you want more information about how to take this medication.
It´s important to take good care of your teeth while you´re taking ALENDRONIC ACID. This is because it might affect your jawbone. You should maintain a good oral hygiene and receive routine dental check-ups. You should report any oral symptoms such as dental mobility, pain, or swelling, non-healing sores or discharge to a doctor and dentist during this treatment.
You should know that a drug holiday from ALENDRONIC ACID should be considered after 5 years of taking this medication.
3. Together with ALENDRONIC ACID, you should take tablets that contain VITAMIN D and CALCIUM to help prevent osteoporosis. Please be aware that you should not take tablets that contain VITAMIN D and CALCIUM within 4 hours of taking ALENDRONIC ACID.
If you have no side effects from these medications, please continue them. Be aware that they are not on your repeat list, so contact the surgery and ask for them to be added to repeat.
4. I recommend you start a new medication to help prevent you from having acid reflux/heartburn - this medication is LANSOPRAZOLE
You will be at risk of having these symptoms because you´ll be on a high dose of PREDNISOLONE for a while.
5. Please eat as little salt as possible. A high-salt diet can raise blood pressure. Taking PREDNISOLONE at high doses for a while puts you at risk of retaining water, which can increase your blood pressure. Also, eating salty foods can cause your body to retain water, leading to leg swelling.
6. I recommend that every 6 months, you check your blood pressure twice a day, ideally once in the morning and once in the evening, while you are sitting down with your back supported and legs uncrossed.
Sit quietly for about 5 minutes before you check your blood pressure.
Each time you do this, take two readings 1 minute apart. You should continue to measure your blood pressure twice daily for at least 4 days, ideally 7 days.
Please send your blood pressure diary to the surgery for a GP to see it.
7. I recommend you have a blood test every 6 months to check if you develop diabetes whilst on high-dose PREDNISOLONE.
8. Have regular consultations for review
I recommend you have follow-up consultations at 1, 3, 6, 9, and 12 months in the first year.
Also, I recommend you have face-to-face consultations any time you feel that your symptoms are more intense than expected (symptoms relapse)
Additionally, whenever you experience side effects from your medication, please book a face-to-face consultation.
9. Whenever you feel pain as you felt before you started the treatment with PREDNISOLONE, you should do 2 things:
- Firstly, increase your PREDNISOLONE dose to the previous dose that controlled your symptoms
For example, if you are on 7 mg PREDNISOLONE daily and you experience pain as you felt before you started the treatment with PREDNISOLONE, you should increase your PREDNISOLONE to 8 mg daily.
- The second thing you should do is to book a telephone appointment with your GP
If there is any term in this Management Plan that that you find difficult to understand, please book a telephone consultation with a nurse. The nurse will explain the meanings of all the words you are not sure about. I am not sure the nurse can answer all your questions related to the clinical aspects of this Management Plan.
I have to stress that I used my clinical judgement when I recommended this Management Plan. If you would like to reconsider or discuss it further, please book a telephone consultation with me.
Prescriptions for the medication mentioned above were sent to your designated pharmacy.
Please be aware that they are not on repeat medication yet. If you have no side effects from these medications, please contact the surgery and ask them to be put on your repeat medication.