Treatment For Polymyalgia Rheumatica

Polymyalgia rheumatica is treated with small amounts of prednisone, such as 10 to 15 mg per day, which usually leads to a dramatic response. This treatment is usually tapered to the minimum amount needed and then maintained for 1 1/2 to 2 years.

Some patients have to stay on corticosteroids for longer. With temporal arteritis the starting dose is much higher (usually 60 mg per day) and this is carefully reduced to the point where the inflammatory process in the cranial arteries is suppressed so that blindness does not occur. Often treatment has to be continued for 3 or 4 years. Some rheumatologists use azathioprine or methotrexate as well to reduce the amount of corticosteroid, but in this case such side effects like bone marrow suppression or liver damage have to be monitored with other blood tests.

The head of the trochanter is particularly sensitive for osteonecrosis and hip replacement surgery may be required in some patients.

However, without treatment there is a high probability of blindness. The physician may find it difficult at times to strike the right balance whether to treat or not, particularly considering the world of litigation that we are living in. Women in menopause should be put on disodium etidronate (brand name: Didrocal), which has been shown to increase the bone mineral densitiy by 4% in one year and 4.8% in 2 years (Ref. 1, p. 59).

Here is a link to another more detailed text regarding treatment of polymyalgia rheumatica.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 14.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 50.

3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

4. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

5. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

6. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.

7. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

Last Modified: Jan. 31, 2008