Treatment can take a year or more, but most people with polymyalgia rheumatica will be better after the first course of treatment. And you'll start to feel better within days. Some people, however, will have a relapse and need additional treatment.
Polymyalgia rheumatica is usually treated with a low dose of an oral corticosteroid, such as prednisone. A daily dose at the beginning of the treatment is usually 10 to 20 milligrams a day.
Relief from pain and stiffness should occur within the first two or three days. If you're not feeling better in a few days, it's likely you don't have polymyalgia rheumatica. In fact, your response to medication is one way your doctor can confirm the diagnosis.
After the first two to three weeks of treatment, your doctor may gradually decrease your dosage depending on your symptoms and the results of sed rate and C-reactive protein tests. The goal is to keep you on as low a dose as possible without triggering a relapse in your symptoms. Most people with polymyalgia rheumatica need to continue the corticosteroid treatment for one to two years. You'll need frequent follow-up visits to monitor how the treatment is working and whether or not you're having any side effects.
People who taper off the medication too quickly are more likely to have a relapse. Twenty percent or more of people with polymyalgia rheumatica will have a least one relapse when tapering off the corticosteroids. About 10 percent of people who successfully finish corticosteroid treatment will have a relapse within 10 years of the initial treatment.
Monitoring side effects
Long-term use of corticosteroids can result in a number of serious side effects. Your doctor will monitor you closely for potential problems. He or she may adjust your dosage and prescribe treatments to manage these reactions to corticosteroid treatment. Side effects include:
- Weight gain. This is a common side effect of corticosteroid therapy.
- Osteoporosis, the loss of bone density and weakening of bones, which increases the risk of bone fractures.
- High blood pressure (hypertension), which increases the risk of cardiovascular disease.
- High cholesterol, which also increases the risk of cardiovascular disease.
- Diabetes, chronic high levels of blood sugar that can cause tissue damage in a number of body systems.
- Cataracts, a clouding of the lenses of your eyes that can cloud or dim your vision .
Calcium and vitamin D supplements
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent osteoporosis induced by corticosteroid treatment. The American Academy of Rheumatology recommends the following daily doses for anyone taking corticosteroids for more than three months:
- 1,000 to 1,200 milligrams (mg) of calcium supplements
- 400 to 1,000 international units (IU) of vitamin D supplements
Several other medications are being studied for use in polymyalgia rheumatica, including:
- Methotrexate (Trexall). This immune-suppressing medication may help lower the dose of corticosteroid that's needed, which can help preserve bone mass. It's often given long term, for a year or more.
- Anti-TNF drugs. TNF stands for tumor necrosis factor, which is a substance that causes inflammation. These drugs block that substance and reduce inflammation. Research results have been mixed on using these medications in polymyalgia rheumatica, but they might be helpful for people who can't take corticosteroids, such as people with diabetes or osteoporosis.
Your doctor may recommend physical therapy to help you regain strength, coordination and your ability to perform everyday tasks after a long period of limited activity that polymyalgia rheumatica often causes.
July 20, 2012
- Hunder GG. Clinical manifestations and diagnosis of polymyalgia rheumatica. http://www.uptodate.com/index. Accessed May 9, 2012.
- Salvarani C, et al. Polymyalgia rheumatica and giant-cell arteritis. The Lancet. 2008;372:234.
- Gonzalez-Gay MA, et al. Medical management of polymyalgia rheumatica. Expert Opinion in Pharmacotherapy. 2010;11:1077.
- Hunder GG. Treatment of polymyalgia rheumatica. http://www.uptodate.com/index. Accessed May 9, 2012.
- Hernandez-Rodriguez J, et al. Treatment of polymyalgia rheumatica. Archives of Internal Medicine. 2009;169:1839.
- Unwin B, et al. Polymyalgia rheumatica and giant cell arteritis. American Family Physician. 2006;74:1547.
- Glucocorticosteroid-induced osteoporosis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gi-osteoporosis.asp. Accessed May 9, 2012.
- Aikawa NE, et al. Anti-TNF therapy for polymyalgia rheumatica: Report of 99 cases and review of the literature. Clinical Rheumatology. 2012;31:575.
- Chang-Miller A (expert opinion). Mayo Clinic, Rochester, Minn. May 15, 2012.