Polymyalgia Rheumatica Journal: Pain and Symptom Tracker, Guided Record Book, Daily Assessment Diary for Mood, Sleep, Activity, Medications and Food in Chronic Autoimmune Disease Management Logbook

Concerns, Symptoms and Pain overall

Concerns- check one of the available triggers or add your own in the lined space left for you

Symptoms - check one of the pre-listed symptoms or add to the lined spaces left available for you. Note that the options include extreme fatigue, headache, morning stiffness, tongue and jaw pain, vision disturbances, sleep disruption, appetite change, hand/wrist/elbow pain, buttocks/upper leg pain, shoulder/neck pain, and more.

Pain location - mark on the image (both front and back are available)

Pain Overall - enter a number ranking, and check one of the pre-listed available or enter your own on the lines available

Weakness and Pain Tracker

Pain Tracker - when weakness, pain or discomfort comes sporadically during the day you can enter the symptom here (along with the trigger if identified), when the symptom occurred, and circle a number to indicate the severity.

Meals & Snacks, and Medications

Enter meals & snacks, when eaten and a note if desired.

There are checkboxes available you can mark to indicate if the meal included dairy, gluten, sugar or fats.

Hydration - mark how much you have had to drink

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Medications - there is a checkbox you can use to indicated just your usual daily medications. There is also a checkbox for usual daily supplements.

If additional meds are taken you can list them, the dose, time and whether it helped.

Daily Assessments, Activities, Weight

Rate your day overall.

Daily Assessment - Circle an arrow to indicate Sleep Quality, Energy Level, Mental Clarity, Pain Level, Stress Level, General Moos, Weakness, and Activity Level (Up, No Change, Down)

Weight - weight loss is common with Polymyalgia

Activities - list them, how long you spent at it, and rate how you felt during the activity.

Checkbox if you want to just say whether or not you exercised.

Sample Completed Page

Sample Completed Page

Personal Information & Healthcare Team

Introductory page has space for personal info including emergency contact, allergies, medical alerts and health conditions.

Enter name, address, phone # for physician, specialists, pharmacy as well as insurance information.

Medications and Changes

Page for current medications / supplements along with reason and refill due date.

Page for CHANGES to medications and supplements with reason for the change, new dose, and date effective.

Upcoming Appointments and Tests/Results

Upcoming medical appointments - with whom? for what reason, and date

Tests, date performed, and the results.

Additional Logs

Left Page

Right Page