Polymyalgia rheumatica medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Polymyalgia rheumatica}} | {{Polymyalgia rheumatica}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{Rim}} | ||
==Overview== | ==Overview== | ||
The mainstay of treatment of polymyalgia rheumatica (PMR) is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]]. | The mainstay of treatment of polymyalgia rheumatica (PMR) is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]]. The starting dose of the [[glucocorticoid]] treatment is 12.5-15 mg daily for 2 to 4 weeks after which the treatment should be slowly tapered. The average duration of the treatment with [[glucocorticoids]] is 1 to 2 years; nevertheless, longer [[corticosteroids]] regimens might be necessary among patients who experience relapse of the symptoms. Prophylaxis for [[osteoporosis]] with [[calcium]] and [[vitamin D]] should be started with the [[steroid]] therapy. | ||
==Medical Therapy== | ==Medical Therapy== | ||
* The mainstay of treatment of PMR is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]] | * The mainstay of treatment of PMR is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]].<ref name="pmid23051717">{{cite journal| author=Kermani TA, Warrington KJ| title=Polymyalgia rheumatica. | journal=Lancet | year= 2013 | volume= 381 | issue= 9860 | pages= 63-72 | pmid=23051717 | doi=10.1016/S0140-6736(12)60680-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23051717 }} </ref> | ||
* | * The symptoms resolution begins within a few days after the initiation of the treatment, and this improvement of the symptoms reinforces the diagnosis of PMR.<ref name="pmid23051717">{{cite journal| author=Kermani TA, Warrington KJ| title=Polymyalgia rheumatica. | journal=Lancet | year= 2013 | volume= 381 | issue= 9860 | pages= 63-72 | pmid=23051717 | doi=10.1016/S0140-6736(12)60680-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23051717 }} </ref> | ||
* During the treatment, the subject's response to treatment should be monitored through | |||
* During the treatment, the subject's response to treatment should be monitored through clinical symptoms and measurement of [[ESR]] or [[CRP]]. | |||
* Treatment lasts as long as needed; however, it normally takes patients several years to get off of the [[steroids]]. The symptoms may come back when the dosage is lowered. The average duration of the treatment with [[glucocorticoids]] is 1 to 2 years; nevertheless, longer [[corticosteroids]] regimens might be necessary among patients who experience relapse of the symptoms. | * Treatment lasts as long as needed; however, it normally takes patients several years to get off of the [[steroids]]. The symptoms may come back when the dosage is lowered. The average duration of the treatment with [[glucocorticoids]] is 1 to 2 years; nevertheless, longer [[corticosteroids]] regimens might be necessary among patients who experience relapse of the symptoms. | ||
* Studies have shown that [[steroids]] increase the patient’s [[blood pressure]]. For this reason, the patient’s [[blood pressure]] is monitored throughout the treatment process. Also, the [[steroids]] lower the patient’s [[immune system]], making them more susceptible to [[infection]] | * Studies have shown that [[steroids]] increase the patient’s [[blood pressure]]. For this reason, the patient’s [[blood pressure]] is monitored throughout the treatment process. Also, the [[steroids]] lower the patient’s [[immune system]], making them more susceptible to [[infection]]. | ||
* Prophylaxis for [[osteoporosis]] with [[calcium]] and [[vitamin D]] should be started along with [[steroid]] therapy. | * Prophylaxis for [[osteoporosis]] with [[calcium]] and [[vitamin D]] should be started along with [[steroid]] therapy. | ||
* [[Infliximab]] use in [[PMR]] has not been proved beneficial and it may be harmful.<ref name="pmid17470831">{{cite journal |author=Salvarani C, Macchioni P, Manzini C, ''et al.'' |title=Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial |journal=Ann. Intern. Med. |volume=146 |issue=9 |pages=631–9 |year=2007 |month=May |pmid=17470831 |doi= |url=}}</ref> | |||
=== | === Polymyalgia rheumatica === | ||
*[[ | * '''1 Glucocorticoids''' | ||
** Preferred regimen (1): [[Prednisone]] 12.5-15 mg PO qd for 2-4 weeks (maximum 40 mg/d) then taper it by decreasing the dose by 2.5 mg every 2 to 4 weeks till reaches 10 mg, then decrease the dose by 1 mg every month | |||
* | * '''2 Glucocorticoid-sparing therapies''' | ||
** Alternative regimen (1): [[Methotrexate]] 10 mg PO every week<ref name="pmid15466766">{{cite journal |author=Caporali R, Cimmino MA, Ferraccioli G, ''et al.'' |title=Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial |journal=Ann. Intern. Med. |volume=141 |issue=7 |pages=493–500 |year=2004 |month=October |pmid=15466766 |doi= |url=}}</ref> | |||
** Alternative regimen (2): [[Etanercept]] 25 mg SC twice weekly | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category: | |||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
[[Category:Up-To-Date]] | |||
Latest revision as of 23:47, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
The mainstay of treatment of polymyalgia rheumatica (PMR) is low dose glucocorticoids, typically prednisone or prednisolone. The starting dose of the glucocorticoid treatment is 12.5-15 mg daily for 2 to 4 weeks after which the treatment should be slowly tapered. The average duration of the treatment with glucocorticoids is 1 to 2 years; nevertheless, longer corticosteroids regimens might be necessary among patients who experience relapse of the symptoms. Prophylaxis for osteoporosis with calcium and vitamin D should be started with the steroid therapy.
Medical Therapy
- The mainstay of treatment of PMR is low dose glucocorticoids, typically prednisone or prednisolone.[1]
- The symptoms resolution begins within a few days after the initiation of the treatment, and this improvement of the symptoms reinforces the diagnosis of PMR.[1]
- During the treatment, the subject's response to treatment should be monitored through clinical symptoms and measurement of ESR or CRP.
- Treatment lasts as long as needed; however, it normally takes patients several years to get off of the steroids. The symptoms may come back when the dosage is lowered. The average duration of the treatment with glucocorticoids is 1 to 2 years; nevertheless, longer corticosteroids regimens might be necessary among patients who experience relapse of the symptoms.
- Studies have shown that steroids increase the patient’s blood pressure. For this reason, the patient’s blood pressure is monitored throughout the treatment process. Also, the steroids lower the patient’s immune system, making them more susceptible to infection.
- Prophylaxis for osteoporosis with calcium and vitamin D should be started along with steroid therapy.
- Infliximab use in PMR has not been proved beneficial and it may be harmful.[2]
Polymyalgia rheumatica
- 1 Glucocorticoids
- Preferred regimen (1): Prednisone 12.5-15 mg PO qd for 2-4 weeks (maximum 40 mg/d) then taper it by decreasing the dose by 2.5 mg every 2 to 4 weeks till reaches 10 mg, then decrease the dose by 1 mg every month
- 2 Glucocorticoid-sparing therapies
- Alternative regimen (1): Methotrexate 10 mg PO every week[3]
- Alternative regimen (2): Etanercept 25 mg SC twice weekly
References
- ↑ 1.0 1.1 Kermani TA, Warrington KJ (2013). "Polymyalgia rheumatica". Lancet. 381 (9860): 63–72. doi:10.1016/S0140-6736(12)60680-1. PMID 23051717.
- ↑ Salvarani C, Macchioni P, Manzini C; et al. (2007). "Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial". Ann. Intern. Med. 146 (9): 631–9. PMID 17470831. Unknown parameter
|month=ignored (help) - ↑ Caporali R, Cimmino MA, Ferraccioli G; et al. (2004). "Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial". Ann. Intern. Med. 141 (7): 493–500. PMID 15466766. Unknown parameter
|month=ignored (help)