From the Guidelines
Polymyalgia rheumatica is an inflammatory condition that causes severe muscle pain and stiffness, primarily affecting people over 50 years old, and is typically treated with low-dose corticosteroids like prednisone, which often provide dramatic relief within days. The condition develops when the lining around joints, tendons, and muscles becomes inflamed, though the exact cause remains unknown.
Key Points
- It typically causes aching and stiffness in the shoulders, neck, upper arms, hips, and thighs, with symptoms often being worst in the morning or after periods of inactivity.
- Treatment usually involves low-dose corticosteroids like prednisone (typically starting at 12.5-25mg daily) 1, which often provide dramatic relief within days.
- The medication is gradually reduced over months or years, with most patients needing treatment for 1-2 years.
- Regular monitoring is necessary to check for side effects of steroids and to watch for giant cell arteritis, a related condition that can cause vision problems.
- While polymyalgia rheumatica can significantly impact quality of life, it typically responds well to treatment and doesn't cause permanent damage to the muscles or joints.
Management
- Assess comorbidities and possible risk factors for steroid-related side effects 1.
- Consider specialist referral, particularly in case of atypical presentation or high risk of therapy-related side effects.
- Document minimal clinical and laboratory dataset before prescribing therapy.
- Use high erythrocyte sedimentation rate (ESR) (>40 mm/1st hour) and peripheral inflammatory arthritis to guide initial glucocorticoid dose 1.
- Methotrexate may be used as a glucocorticoid-sparing agent in patients with high risk of relapse or prolonged therapy 1.
From the Research
What is Polymyalgia Rheumatica (PMR)
- PMR is a common disease in individuals older than 50 in the western world, characterized by bilateral inflammatory pain involving the shoulder girdle and less commonly the neck and pelvic girdle 2
- The main goals of treatment are to induce remission and prevent relapse 2
Symptoms and Treatment
- Patients with isolated PMR experience a rapid response to 12.5-25 mg/prednisone/day 2
- Methotrexate is the conventional disease-modifying antirheumatic drug most commonly used for disease management, especially for relapses of the disease 2, 3, 4, 5, 6
- Glucocorticoid-sparing agents, such as methotrexate, have been tested and shown to be effective in reducing prednisone dose and improving inflammatory activity 3, 4, 5, 6
Management and Outcomes
- Starting prednisone doses higher than 10 mg/d were associated with fewer relapses and shorter therapy than were lower doses 3
- Slow prednisone dose tapering (<1 mg/mo) was associated with fewer relapses and more frequent glucocorticoid treatment cessation than faster tapering regimens 3
- Methotrexate was associated with improved inflammatory activity and reduced prednisolone dose, with a relatively high risk of adverse events 6