Polymyalgia rheumatica medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

The mainstay of treatment of polymyalgia rheumatica (PMR) is low dose glucocorticoids, typically prednisone or prednisolone. The starting dose of the glucocorticoid treatment is 15-20 mg daily for 2 to 4 weeks after which the treatment should be slowly tapered. The average duration of the treatment with glucocorticoids is 1 to 2 years; nevertheless, longer corticosteroids regimens might be necessary among patients who experience relapse of the symptoms. Prophylaxis for osteoporosis with calcium and vitamin D should be started with the steroid therapy.[1]

Medical Therapy

  • The symptoms resolution begins within a few days after the initiation of the treatment, and this improvement of the symptoms reinforces the diagnosis of PMR.[1]
  • During the treatment, the subject's response to treatment should be monitored through clinical symptoms and measurement of ESR or CRP.
  • Treatment lasts as long as needed; however, it normally takes patients several years to get off of the steroids. The symptoms may come back when the dosage is lowered. The average duration of the treatment with glucocorticoids is 1 to 2 years; nevertheless, longer corticosteroids regimens might be necessary among patients who experience relapse of the symptoms.

Polymyalgia rheumatica

  • 1 Glucocorticoids
    • Preferred regimen (1): Prednisone 15-20 mg PO qd for 2-4 weeks (maximum 40 mg/d) then taper it by decreasing the dose by 2.5 mg every 2 to 4 weeks till reaches 10 mg, then decrease the dose by 1 mg every month
    • Alternative regimen (1): Methotrexate [3]
    • Alternative regimen (2): Etanercept

References

  1. 1.0 1.1 1.2 Kermani TA, Warrington KJ (2013). "Polymyalgia rheumatica". Lancet. 381 (9860): 63–72. doi:10.1016/S0140-6736(12)60680-1. PMID 23051717.
  2. Salvarani C, Macchioni P, Manzini C; et al. (2007). "Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial". Ann. Intern. Med. 146 (9): 631–9. PMID 17470831. Unknown parameter |month= ignored (help)
  3. Caporali R, Cimmino MA, Ferraccioli G; et al. (2004). "Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial". Ann. Intern. Med. 141 (7): 493–500. PMID 15466766. Unknown parameter |month= ignored (help)

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