From the Guidelines
Polymyalgia rheumatica (PMR) symptoms should be managed with an initial prednisone dose of 20 mg/day to reduce short-term relapse rates, as indicated by recent evidence 1. The symptoms of PMR typically include severe muscle pain and stiffness in the shoulders, neck, and hips, especially in the morning or after periods of inactivity. Patients often experience difficulty raising their arms above shoulder level, getting up from a chair, or climbing stairs. Fatigue, mild fever, weight loss, and general malaise are also common. Some key points to consider in managing PMR symptoms include:
- The use of intramuscular methylprednisolone as a potential glucocorticoid (GC) sparing agent, which may have comparable efficacy to oral GCs with lower cumulative GC doses and less weight gain 1.
- The potential benefit of methotrexate in improving remission rates and reducing cumulative GC doses in early PMR, as supported by moderate to high quality evidence 1.
- The importance of monitoring for prognostic factors, such as female sex, high erythrocyte sedimentation rate (ESR), and peripheral arthritis, which may be associated with a higher relapse risk and longer duration of treatment 1. It is essential to note that the evidence for initial GC doses and subsequent tapering regimens in PMR is limited, and further research is needed to inform optimal treatment strategies 1.
From the Research
PMR Symptoms
- Polymyalgia rheumatica (PMR) is characterized by bilateral inflammatory pain involving the shoulder girdle and less commonly the neck and pelvic girdle 2.
- The main symptoms of PMR include pain and stiffness in the shoulders, neck, and hips, which can be severe enough to limit daily activities 3.
- PMR is a common disease in individuals older than 50 in the western world, and its symptoms can be similar to those of other conditions, making diagnosis challenging 4.
Diagnosis and Treatment
- The diagnosis of PMR is based on clinical clues, including the presence of bilateral shoulder pain and stiffness, and elevated levels of inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 3.
- Treatment of PMR typically involves the use of corticosteroids, such as prednisone, which can provide rapid relief from symptoms 2, 3.
- Methotrexate is often used as a corticosteroid-sparing agent to reduce the dose of prednisone required to control symptoms 2, 5.
- Tocilizumab, an anti-interleukin-6 receptor antibody, has been shown to be effective in treating PMR in some cases, particularly in patients who are resistant to glucocorticoids 6.
Disease Management
- The goal of treatment in PMR is to induce remission and prevent relapse, which can be achieved through the use of corticosteroids and other medications such as methotrexate and tocilizumab 2, 4.
- Regular follow-up and monitoring of disease activity are important to adjust treatment and prevent complications such as osteoporosis 3, 4.
- Non-pharmacological interventions, such as exercise and physical therapy, can also be beneficial in managing PMR symptoms and improving quality of life 4.