Treatments and drugs

By Mayo Clinic Staff

Treatment usually involves medications to help ease your symptoms. Relapses are common.

Corticosteroids

Polymyalgia rheumatica is usually treated with a low dose of an oral corticosteroid, such as prednisone. A daily dose at the beginning of treatment is usually 10 to 20 milligrams a day.

You'll likely start to feel relief from pain and stiffness within the first two or three days. If you aren't responding to treatment, your doctor may refer you to a rheumatologist.

After the first two to four weeks of treatment, your doctor may gradually decrease your dosage depending on your symptoms and the results of blood 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 at least a year. You'll need frequent follow-up visits with your doctor to monitor how the treatment is working and whether you're having any side effects.

People who taper off the medication too quickly are more likely to have a relapse. Thirty to 60 percent of people with polymyalgia rheumatica will have at least one relapse when tapering off the corticosteroids. Relapses (flares) are treated by increasing your drug dosage for a while then tapering again.

Monitoring side effects

Long-term use of corticosteroids can result in a number of serious side effects. Your doctor will monitor you closely for problems. He or she may adjust your dosage and prescribe treatments to manage these reactions to corticosteroid treatment. Possible side effects include:

  • Weight gain
  • Osteoporosis — the loss of bone density and weakening of bones
  • High blood pressure (hypertension)
  • Diabetes
  • Cataracts — a clouding of the lenses of your eyes

Calcium and vitamin D supplements

Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss induced by corticosteroid treatment. The American Academy of Rheumatology recommends the following daily doses for anyone taking corticosteroids:

  • 1,200 to 1,500 milligrams (mg) of calcium supplements
  • 800 to 1,000 international units (IU) of vitamin D supplements

Pneumonia vaccine

Your doctor may suggest you get a pneumonia vaccine if you are taking 20 milligrams or more of prednisone a day.

Other medications

Several other medications are being studied for use in polymyalgia rheumatica, including:

  • Methotrexate (Trexall). Three studies show mixed results for the usefulness of this immune-suppressing medication when taken with prednisone. Two studies show that methotrexate is useful as an initial treatment. Another shows that it doesn't help lower the dose of corticosteroid that's needed, which can help preserve bone mass.
  • Anti-TNF drugs. TNF stands for tumor necrosis factor, which is a substance that causes inflammation. Anti-TNF drugs block that substance and reduce inflammation. Research results are mixed on using these drugs to treat polymyalgia rheumatic. But studies also show that they might be helpful for people with polymyalgia rheumatica who can't take corticosteroids, such as those with diabetes or osteoporosis.

Physical therapy

You may benefit from physical therapy if you've had a long stretch of limited activity owing to polymyalgia rheumatica. Talk with your doctor about whether physical therapy is a good option for you if you're trying to regain strength, coordination and the ability to perform everyday tasks.

July 14, 2015