Treatment usually involves medications to help ease your symptoms. Relapses are common.
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)
- 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
Your doctor may suggest you get a pneumonia vaccine if you are taking 20 milligrams or more of prednisone a day.
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.
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
- Kermani TA, et al. Polymyalgia rheumatica. The Lancet. 2013;381:63.
- AskMayoExpert. Polymyalgia rheumatica. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
- Bhaskar D, et al. 2012 provisional classification criteria for polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis & Rheumatism. 2012;64:943.
- Kermani TA, et al. Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. Therapeutic Advances in Musculoskeletal Disease. 2014;6:8.
- Wyand CM, et al. Giant-cell arteritis and polymyalgia rheumatica. New England Journal of Medicine. 2014;371:50.
- Salvarani C, et al. Clinical features of polymyalgia rheumatica and giant cell arteritis. Nature Reviews Rheumatology. 2012;8:509.
- Matteson EL, et al. Diagnosis and assessment of polymyalgia rheumatica: A step forward. Aging Health. 2012;8:395.
- Aikawa NE, et al. Anti-TNF therapy for polymyalgia rheumatica: Report of 99 cases and review of the literature. Clinical Rheumatology. 2012;31:575.
- Glucocorticosteroid-induced osteoporosis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gi-osteoporosis.asp. Accessed May 1, 2015.
- Saag KG, et al. Major side effects of systemic glucocorticoids. www.uptodate.com/home. Accessed May 7, 2015.
- Colditz GA. Healthy diet in adults. www.uptodate.com/home. Accessed May 18, 2015.