Polymyalgia rheumatica medical therapy

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 12.5-15 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.

Medical Therapy

The mainstay of treatment of PMR is low dose glucocorticoids, typically prednisone or prednisolone.^[1]

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.

Studies have shown that steroids increase the patient’s blood pressure. For this reason, the patient’s blood pressure is monitored throughout the treatment process. Also, the steroids lower the patient’s immune system, making them more susceptible to infection.
Prophylaxis for osteoporosis with calcium and vitamin D should be started along with steroid therapy.
Infliximab use in PMR has not been proved beneficial and it may be harmful.^[2]

Polymyalgia rheumatica

1 Glucocorticoids
- Preferred regimen (1): Prednisone 12.5-15 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
2 Glucocorticoid-sparing therapies
- Alternative regimen (1): Methotrexate 10 mg PO every week^[3]
- Alternative regimen (2): Etanercept 25 mg SC twice weekly

References

↑ ^1.0 ^1.1 Kermani TA, Warrington KJ (2013). “Polymyalgia rheumatica”. Lancet. 381 (9860): 63–72. doi:10.1016/S0140-6736(12)60680-1. PMID 23051717.
↑ 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)
↑ 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)

[pmid23051717-1] 1.0 ^1.1 Kermani TA, Warrington KJ (2013). “Polymyalgia rheumatica”. Lancet. 381 (9860): 63–72. doi:10.1016/S0140-6736(12)60680-1. PMID 23051717.

[pmid17470831-2] 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)

[pmid15466766-3] 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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