From the Guidelines
For the initial treatment of polymyalgia rheumatica (PMR), the recommended starting dose of prednisone is typically 12.5-25 mg daily, as conditionally recommended by the panel 1. Most patients respond well to this dose range as an initial treatment. The medication should be taken in the morning with food to minimize gastrointestinal side effects. After starting treatment, patients usually experience dramatic symptom improvement within 24-72 hours, which helps confirm the diagnosis. This initial dose should be maintained for 2-4 weeks until symptoms are well-controlled, then gradually tapered. A typical tapering schedule might reduce the dose by 2.5 mg every 2-4 weeks until reaching 10 mg daily, followed by slower reductions of 1 mg every 4 weeks, as suggested by the panel 1. The total duration of therapy often ranges from 1-2 years. Calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplementation should be initiated concurrently to prevent steroid-induced osteoporosis. Prednisone works in PMR by suppressing the inflammatory process that causes the characteristic shoulder and hip girdle pain and stiffness. Regular monitoring for steroid side effects and disease activity is essential throughout treatment, and the panel strongly recommends against the use of initial doses >30 mg/day and conditionally discourages low (≤7.5 mg/day) initial GC doses 1. Some patients may require a higher initial prednisone dose within the recommended range if they have a high risk of relapse and low risk of adverse events, whereas patients with relevant comorbidities may prefer a lower dose 1. The choice of treatment should be individualized based on the patient's specific needs and risk factors. In addition to prednisone, the panel conditionally recommends considering early introduction of methotrexate (MTX) in addition to GCs, particularly in patients at a high risk for relapse and/or prolonged therapy, as well as in cases with risk factors, comorbidities, and/or concomitant medications where GC-related adverse events are more likely to occur 1. Overall, the goal of treatment is to achieve remission while minimizing the risk of adverse events and improving the patient's quality of life. The panel's recommendations are based on the best available evidence and should be taken into consideration when making treatment decisions for patients with PMR 1.
From the FDA Drug Label
The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required There is no specific information in the label about the initial diagnosis of PMR (Polymyalgia Rheumatica), therefore, the dose for this condition cannot be determined from this information alone 2.
From the Research
Initial Diagnosis of PMR
The initial diagnosis of Polymyalgia Rheumatica (PMR) is typically treated with corticosteroids, specifically prednisone.
- The recommended initial dose of prednisone for PMR varies, but most studies suggest a dose of 10-20 mg/day 3, 12.5-25 mg/day 4, or 15 mg/d 5.
- A study found that 12.5 mg prednisone/day is a sufficient starting dose in approximately 78% of PMR patients, with the main factor driving response to prednisone being body weight 6.
- Another study used a higher initial dose of 25 mg/d, which was then tapered to 0 mg/d within 24 weeks 7.
Response to Treatment
- Clinical improvement is generally achieved within 7 days of the onset of prednisone therapy 3.
- A good response to prednisone is predicted by low body weight, with a mean prednisone dose per kg of 0.19±0.03 mg in responders compared to 0.16±0.03 mg in non-responders 6.
- Starting prednisone doses higher than 10 mg/d are associated with fewer relapses and shorter therapy, while starting doses of 15 mg/d or lower are associated with lower cumulative glucocorticoid doses 5.