From the Guidelines
Polymyalgia rheumatica (PMR) is not typically associated with heel pain as a primary symptom, and if you're experiencing heel pain alongside diagnosed PMR, the heel pain is likely a separate condition such as plantar fasciitis, Achilles tendinitis, or heel bursitis. For managing PMR, low-dose oral prednisone (12.5-25 mg daily) is the standard treatment, usually providing dramatic symptom relief within 24-48 hours 1. This dose is gradually tapered over months to years while monitoring symptoms. For the heel pain, treatment depends on the specific diagnosis but generally includes rest, ice, over-the-counter NSAIDs like ibuprofen (400-800 mg three times daily with food), supportive footwear, stretching exercises, and possibly night splints or orthotic inserts 1. Some key points to consider in the management of PMR and heel pain include:
- The use of glucocorticoids, such as prednisone, is strongly recommended for PMR treatment, with the minimum effective dose and duration of treatment individualized for each patient 1.
- The initial prednisone dose should be within the range of 12.5–25 mg daily, with higher doses considered for patients at high risk of relapse and lower doses for those with comorbidities or risk factors for glucocorticoid-related side effects 1.
- For heel pain, patient-directed measures such as calf-muscle stretching, cryotherapy, and weight loss (if indicated) may be beneficial, in addition to NSAIDs, padding and strapping of the foot, and corticosteroid injections in appropriate patients 1. It's essential to consult a healthcare provider for proper diagnosis and treatment of both PMR and heel pain, as the glucocorticoids used to treat PMR might partially mask heel pain symptoms but won't necessarily resolve the underlying cause of localized heel issues 1.
From the Research
Polymyalgia Rheumatica and Heel Pain
- There is no direct evidence in the provided studies that links polymyalgia rheumatica (PMR) to heel pain specifically.
- However, PMR is characterized by bilateral inflammatory pain involving the shoulder girdle and less commonly the neck and pelvic girdle 2.
- The main goals of PMR treatment are to induce remission and prevent relapse, with glucocorticoids being the primary treatment 3, 4, 5, 2, 6.
- Some studies suggest that PMR treatment may involve glucocorticoid-sparing agents, such as methotrexate, to reduce the side effects associated with prolonged glucocorticoid use 3, 4, 5, 2, 6.
- Biologic agents, like anti-IL-6 receptor agents (e.g., tocilizumab and sarilumab), have shown efficacy in reducing relapse frequency and achieving long-term remission of PMR 3, 2.
Treatment of Polymyalgia Rheumatica
- The agreed-upon treatment for PMR is prednisone or prednisolone at a dose ranging between 12.5 and 25 mg/day 3, 4, 5, 2, 6.
- Methotrexate is the most commonly used conventional disease-modifying antirheumatic drug (DMARD) for PMR management, especially for relapses of the disease 3, 4, 5, 2, 6.
- Other biologic agents and Janus kinase (JAK) inhibitors are currently under investigation for PMR treatment 3, 2.