From the Guidelines
Polymyalgia rheumatica (PMR) is primarily treated with low-dose oral glucocorticoids, with prednisone being the most commonly used medication, at a recommended starting dose of 12.5-25 mg daily. The treatment approach is based on the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR 1.
Key Treatment Principles
- The initial dose of prednisone should be within the range of 12.5-25 mg daily, with the choice of dose depending on the patient's risk of relapse and adverse events 1.
- After 2-4 weeks of initial therapy with good symptom control, the dose should be gradually tapered by 2.5 mg every 2-4 weeks until reaching 10 mg daily, then more slowly by 1 mg decrements every 4 weeks 1.
- For patients who cannot tolerate or have contraindications to glucocorticoids, methotrexate (7.5-20 mg weekly) or leflunomide (10-20 mg daily) may be used as steroid-sparing agents 1.
- All patients on glucocorticoid therapy should receive calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplementation to prevent osteoporosis, and bisphosphonates should be considered for those at high risk of fractures.
Monitoring and Follow-Up
- Regular monitoring for glucocorticoid side effects and disease activity is essential, with follow-up visits recommended every 4-8 weeks during the initial treatment phase.
- The effectiveness of treatment is based on clinical response rather than laboratory markers alone, with the goal being complete resolution of symptoms while minimizing medication side effects.
Prognostic Factors and Future Directions
- Female sex, high erythrocyte sedimentation rate (ESR), and peripheral arthritis are potential risk factors for a worse prognosis, although the evidence supporting these factors is only fair to moderate 1.
- Future studies are needed to clarify the optimal dose of methotrexate and the potential benefits of other treatments, such as tocilizumab and secukinumab, in PMR.
From the FDA Drug Label
INDICATIONS AND USAGE PredniSONE Tablets are indicated in the following conditions: ... 2 Rheumatic Disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: ... Rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy) ... Polyarthalgia is not explicitly mentioned, however, rheumatoid arthritis is, which can be associated with polyarthalgia. The current treatment for polyarthalgia reumatica is not directly stated in the provided drug labels, but based on the information provided for rheumatoid arthritis, prednisone (PO) may be considered as an adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation 2.
From the Research
Current Treatment for Polyarthalgia Rheumatica
The current treatment for polyarthalgia rheumatica (PMR) involves the use of glucocorticoids, such as prednisone or prednisolone, at a dose ranging between 12.5 and 25 mg/day 3. However, due to the side effects associated with prolonged glucocorticoid use, glucocorticoid-sparing agents have emerged as tools in the management of PMR.
Glucocorticoid-Sparing Agents
- Methotrexate has traditionally been the conventional disease-modifying antirheumatic drug (DMARD) unanimously recommended for use in PMR 3, 4.
- Other conventional DMARDs, such as leflunomide, have shown promising results but require further study 3.
- Biologic agents, such as anti-IL-6 receptor agents (e.g., tocilizumab and sarilumab), have demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease 3, 4.
Disease Management
- Patients with PMR can be subdivided into distinct groups based on their response to therapy and disease duration 5.
- Pretreatment erythrocyte sedimentation rate and nonresponsiveness of interleukin 6 to steroid therapy can help divide patients into subsets with different treatment requirements 5.
- The use of biologic agents has marked a significant step forward in the management of PMR, offering alternatives to traditional therapies and improving symptoms and reducing glucocorticoid use 3, 4.