I have a 20 year history of positive ANA, ( I am 43, female) diffuse speckled pattern, (used myself as a negative control which did not work out so well.) I have had mono articular attacks over the years but never any conclusive results. I just experienced a flu like episode leading to the most sever bone pain in my pelvic girdle and muscle pain in my buttocks, thighs, calves, and shoulders I have ever experienced. My PCP is concerned of PMR as I have also had significant changes in vision over the last 4-6 months, constant headaches, and now sudden increase in LFT s of AST 299 and ALT 499 when completely normal in January. I have significant family history of aggressive cancers and wish to decide if a PET CT is now my next best test. My only element that is not coinciding with PMR is an ESR of only 2. What would you recommend as the next step in treatment and to ascertain if the PMR symptoms are primary or actually secondary to an undiagnosed cancer?